THE MANYFACES
OF
EXCLUSIONEND OF CHILDHOOD REPORT 2018

Six-year-old Arwa* and her family
were displaced from their home byarmed conflict in Iraq.

CONTENTS
1Introduction

3	End of Childhood Index Results2017 vs. 2018
7	
THREAT #1: Poverty
15 THREAT #2: Armed Conflict
21	
THREAT #3: Discrimination
Against Girls
27 Recommendations
31	End of Childhood Index
Rankings
32	Complete End ofChildhood Index 201836	Methodology andResearch Notes
41 Endnotes
45 Acknowledgements* after a name indicates the name has beenchanged to protect identity.

Published by Save the Children
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www.SavetheChildren.org© Save the Children Federation, Inc.
ISBN: 1-888393-34-3## SAVE
THE CHILDREN
Photo:CJ Clarke/ Save the Children

INTRODUCTION

The Many Faces of Exclusion
Poverty, conflict and discrimination against girls are putting more than 1.2 billion
children – over half of children worldwide – at risk for an early end to theirchildhood. Many of these at-risk children live in countries facing two or three ofthese grave threats at the same time. In fact, 153 million children are at extreme
risk of missing out on childhood because they live in countries characterized by
all three threats.1
In commemoration of International Children’s Day,
Save the Children releases its second annual End of Childhood
Index, taking a hard look at the events that rob childrenof their childhoods and prevent them from reaching theirfull potential.
Compared to last year, the index finds the overall situation
for children appears more favorable in 95 of 175 countries.
This is welcome news – and it shows that investments andpolicies are working to lift up many of our children. But theindex also shows progress is not happening fast enough, andconditions appear considerably worse in about 40 countries.
Lost childhoods are increasingly concentrated among thepoorest children and children affected by conflict. These
conditions tend to exacerbate gender bias and increase
negative experiences that end childhood for girls.
The index compares countries by a set of indicators
representing life-changing events that signal the disruption ofchildhood: poor health, malnutrition, exclusion from education,
child labor, child marriage, early pregnancy and extreme
violence. These “childhood enders” are most prevalent where
poverty, conflict and gender bias overlap to create toxic
environments for children. Not surprisingly, the 20 countries
characterized by all three of these threats all fall in thebottom third of the index. Half (10 countries) are in thebottom 20, and seven are in the bottom 10.
Lost childhoods are a result of choices that exclude
particular groups of children by design or neglect. A child’s
experience of childhood is largely determined by the careand protection they receive, or fail to receive, from adults.
Children have the right to survival, food and nutrition,
health and shelter. Children also have the right to be
encouraged and educated, both formally and informally.
And they have the right to live free from fear, safe fromviolence and protected from abuse and exploitation.
In 2015, world leaders gathered at the United Nations tomake a bold commitment – to end poverty in all its forms by

WHO ARE THE 1.2 BILLION
CHILDREN AT RISK?
THREAT #1

1 billion children live in countries plagued bypoverty.2 Children living in poverty face a higher riskof death before age 5, malnutrition that stunts their
growth, being out of school, being forced into childlabor or early marriage, and giving birth while they
are still children themselves.
THREAT #2

At least 240 million children live in countries
affected by conflict and fragility.3 These children
are at heightened risk of death before age 5, stunted
growth due to malnutrition, being out of school, being
forced to work, and being forced from their homes
under dangerous and frightening circumstances.
THREAT #3

575 million girls live in countries characterized
by discrimination against girls,4 often placing
them at heightened risk of death before age 5, being
denied education, being forced into early marriage,
and/or giving birth before they are emotionally andphysically ready.
Because of who they are and where they live, thesechildren risk being robbed of their childhoods andfuture potential. This assault on childhood also deprives
nations of energy and talent they need to progress.

ENDOF
OFCHILDHOOD
CHILDHOODREPORTREPORT ##1
END

2030 and protect the planet for future generations. Taken
together, the Sustainable Development Goals (SDGs) they
established paint a vision of a future in which all children enjoy
their rights to health, education and protection – in short,their right to childhood.5 Crucially, signatories to the newagreement promised to ensure this would happen for all
segments of society – regardless of income, geography, genderor identity. And they promised that those who are furthest
behind – the most excluded in society – would be reached first.
This pledge to leave no one behind must be upheld. Only
then will we realize its potential to transform the lives of
millions of children across the world, guaranteeing every
last child the childhood they deserve.

2000 and around 2014, the stunting gap between thepoorest 20 percent and richest 20 percent of children
under 5 has either remained the same or increased.13
6.

Although rates are declining, the absolute numberof stunted children in sub-Saharan Africa is on therise. West and Central Africa bears a disproportionate
burden of this increase, with the number of stunted
children rising from 22.9 million in 2000 to 28.1 million
in 2016.14 While stunting rates are falling steadily acrossthe region, few countries on the continent are on track
to meet the SDG nutrition target.15 Globally, if current
inadequate progress continues, there will be 130 million
stunted children in 2025 (instead of the target of
99 million) and sub-Saharan Africa will account for
more than half of them (compared with about
one-third today).16

7.

Survival gaps in sub-Saharan Africa have increased,
as progress in saving lives has favored better-off children.
And while progress in other regions has favored thepoorest, no region is on track to close its child mortality
gap by 2030, and most will not achieve equity in under-5
mortality rates between the poorest and richest
households even by 2050.17 Despite the remarkableglobal progress since 2000, even if current rates ofdecline are sustained, more than 60 million more children
will die before age 5 between now and 2030, mostly frompreventable causes. About half will be newborn babies.18

8.

Progress ensuring all children receive a full courseof primary and secondary school has stalled.
The number of children excluded from education fell
steadily in the decade following 2000, but progress has
essentially stopped in recent years. And with population
growth in lower-performing regions, there will be little
reduction in the global number of children out of schoolin 2030 compared to today (263 million).19 Also, atleast 400 million children are in school but not learning(i.e., they are unable to read or undertake basic
mathematics).20

9.

Education systems in sub-Saharan Africa are
struggling to keep up with population growth.
Across the region, progress reducing out-of-school rates
has stagnated and the number of out-of-school children
has been steadily increasing for at least the past five
years. As a result, the share of the global out-of-school
population residing in sub-Saharan Africa has risen
to 37 percent, up from 24 percent in 2000.21

10 major trends that require urgent action
1.

2.

3.

4.

5.

2

The world is now witnessing the highest levelsof displacement on record, with 20 people newly
displaced every minute of every day as a result ofconflict or persecution. By the end of 2016, more than
65 million people around the world had been forcibly
displaced from their homes, including an estimated
28 million children.6 The number of children living
in conflict zones is also up, from 1 in 10 in the early
1990s to 1 in 6 in 2016.7
By 2030, over 150 million more girls will marry
before their 18th birthday.8 Despite global progress,
no region is on track to eliminate child marriage by2030. All regions need faster progress, but Latin America
and the Caribbean – with virtually no progress since the1990s – needs to speed up its rate of decline enormously.
And in sub-Saharan Africa, due to population growth,
the number of child brides will rise unless the rate of
decline more than doubles.9
The global number of adolescent pregnancies is set
to increase. Although the prevalence of pregnancies
among adolescent girls appears to be declining in all
regions but Latin America and the Caribbean,10 because
the global population of adolescents continues to grow,projections indicate the number of girls under age
18 giving birth each year will increase globally fromabout 7.8 million today to 8.8 million by 2030. The
greatest proportional increases are likely to be in West
and Central Africa and Eastern and Southern Africa.11
The rich-poor child marriage gap has increased
globally. Over the course of about two decades, thegap in global levels of child marriage between girls fromthe richest and poorest families roughly doubled. Today,
the poorest girls are 4 times as likely as the richest to
marry in childhood (41 percent vs. 10 percent); in 1990
they were twice as likely (39 percent vs. 19 percent).12
The rich-poor stunting gap has increased in most
low-income countries. For 24 of 27 low-income
countries with comparable trend data between around

SAVE THE CHILDREN

10. Child labor rates have risen in sub-Saharan Africa.
From 2012 to 2016, child labor in sub-Saharan Africarose from 21 to 22 percent, while all other regions
achieved declines. The region has also been among
those most affected by conflict and poverty, whichheighten the risk of child labor.22

End of Childhood Index Results2017 vs. 2018
Save the Children’s second annual End of Childhood Index compares the latest datafor 175 countries and assesses where the most and fewest children are missingout on childhood. Singapore and Slovenia tie for top place in the ranking withscores of 987. Seven other Western European countries also rank in the top 10,
attaining very high scores for children’s health, education and protection status.
Niger ranks last among countries surveyed, scoring 388.
The 10 bottom-ranked countries – eight from West andCentral Africa – are a reverse image of the top, performing
poorly on most indicators. Children in these countries are
the least likely to fully experience childhood, a time thatshould be dedicated to emotional, social and physicaldevelopment, as well as play. In these and many other

WHAT DO THE SCORES MEAN?
End of Childhood Index scores for countries arecalculated on a scale of 1 to 1,000. Countries withhigher scores do a better job of protecting childhoods.
The scores measure the extent to which children ineach country experience “childhood enders” such as
death, chronic malnutrition, being out of school andbeing forced into adult roles of work, marriage
and motherhood. Here’s a quick guide on how tointerpret country scores:
940 or above.. . . Few children missing out on childhood
760 to 939. . . . . . . . Some children missing out on childhood
600 to 759. . . . . . . . Many children missing out on childhood
380 to 599. . . . . . . . Most children missing out on childhood
379 or below.. . . Nearly all children missing out onchildhood
For more details, see the Methodology and Research
Notes beginning on page 36.

countries around the world, children are robbed ofsignificant portions of their childhoods.
The United States, Russia and China may well be the threemost powerful countries in the world – in terms of their
combined economic, military and technological strength andglobal influence – but all three badly trail most of Western

2018 END OF CHILDHOOD
INDEX RANKINGS
TOP 10

BOTTOM 10RANK COUNTRYRANK COUNTRY

1

Singapore

166

DR Congo

1

Slovenia

167

Sierra Leone

3

Norway168

Guinea3

Sweden169

Nigeria5

Finland170

Somalia6

Ireland

171

South Sudan

6

Netherlands

172

Chad

8

Iceland173	Central African Republic

8

Italy

174

8

South Korea 175

Mali
Niger

END OF CHILDHOOD REPORT3

IN MOST OF THE WORLD, CONDITIONS FOR CHILDREN HAVE IMPROVED

Score has increased
No change in score
Score has decreased
No data

Compared to last year, the End of Childhood Index finds the overallsituation for children appears more favorable in 95 countries and conditions
appear worse in 58 countries. Although countries in every region have seen
declines, falling scores are disproportionately concentrated in sub-SaharanAfrica, South Asia and Latin America and the Caribbean.

Europe in helping children reach their full potential. The
United States ranks 36th, Russia ranks 37th and China ranks
40th. Their scores are 945, 944 and 939, respectively – at least
30 points behind most Western European countries (although
it must be noted that China has achieved tremendous
progress since the 1980s).
How countries deal with poverty, conflict and genderbias account in large measure for their placement in theindex.23 These three major threats to childhood have atremendous influence on the presence and severity of theeight key “childhood enders” we use for the index. In fact,
nearly 90 percent of countries in the bottom third of theindex are facing at least one threat, compared to less than
10 percent of countries in the top third.
A comparison of scores shows that 95 countries have madeprogress in the past year in creating conditions for children
to have full and stable childhoods. These successes show thatmany relatively poor countries are making progress, andpolitical choices can matter more than national wealth. End ofChildhood Index scores for 58 countries declined (42 of them
4

SAVE THE CHILDREN

more than a point or two), while the scores remain the samefor 19 countries.24•

In sub-Saharan Africa, 25 of 49 countries (51 percent)improved their scores. Uganda achieved a 20-point scoreincrease, from 681 to 701, mostly due to better childnutrition. Somalia increased its score by 13 points, from470 to 483, signaling that country may be recoveringfrom decades of stagnation and decline. Niger increased
its score 4 points (from 384 to 388); Mali is up 6 points(from 414 to 420) and Sierra Leone is up 7 points (from546 to 553), showing trends are moving in a positive
direction even in some of the lowest-ranked countries.
Nigeria had the greatest decline in the region, dropping
65 points, from 578 to 513, because malnutrition andchild labor rates have been revised upward. Liberia’sscore dropped 50 points, from 681 to 631, because
more children are out of school.

•

In South Asia, 4 of 8 countries improved their scores.
Bangladesh made the most progress in the region,

raising its score 21 points, from 680 to 701, mostly bygetting more children into school. India’s reduced rate ofchild marriage helped increase its score 14 points, from
754 to 768. Afghanistan’s score fell 10 points, from602 to 592, because of conflict-related displacement
and children out of school.

•

In East Asia and the Pacific, 16 of 21 countries(76 percent) made progress. China increased its
score 11 points, from 928 to 939, mostly by improving
enrollment rates and nutritional status of children.
Thailand’s score is up 11 points, from 852 to 863, due
primarily to improved nutrition. The Philippines’ score
dropped 8 points, from 807 to 799, driven by anincrease in stunting.

•In the Middle East and North Africa, just under half
the countries (8 of 17) made progress. Sudan’s score isup 28 points, from 639 to 667, because of fewer children
displaced from home, improved child health and morechildren in school. The scores for Syria and Yemen
dropped 12 points and 5 points, respectively – Syria
from 668 to 656 and Yemen from 653 to 648 – due tothe effects of conflict on children’s health, education andsafety. Qatar’s score dropped 8 points, from 947 to 939,
due primarily to more children out of school.

•

In Latin America and the Caribbean, 61 percent ofcountries (17 of 28) showed improvement. Progress inprotecting children from child labor was the main force
behind Peru’s 30-point score increase and El Salvador’s
24-point rise. Peru’s score went from 788 to 818, andEl Salvador’s from 723 to 747. Scores for Panama and
Venezuela dropped the most, 8 points, from 800 to 792
and 724 to 716, respectively. In Panama, the out-of-schoolrate is up.Venezuela’s decline is mostly driven by children
out of school, but child mortality and displacement rates
are also up.

•

In Central and Eastern Europe and theCommonwealth of Independent States, 11 of
21 countries (52 percent) increased scores. Georgia
achieved a 36-point increase, rising from 851 to 887, due
to reductions in child labor. Uzbekistan’s score rose
22 points, from 862 to 884, due to improvements in childsurvival. Kyrgyzstan is up 9 points, from 816 to 825,
because of better school enrollment. And Macedonia
fell 10 points, from 910 to 900, because child mortality
and out-of-school rates are up.

•

Almost all developed countries have little or nochange in their scores – 25 of 30 countries moved
2 or fewer points in either direction. The biggest movers
are Malta (up 8 points from 953 to 961) and Latvia(up 7 points from 956 to 963). Sweden’s score rose
3 points, from 982 to 985, making it tied with Norway
for third place among all countries in the index.

Overall, the data collected for the End of Childhood Index
document tremendous gaps between rich and poor

countries and the urgent need to accelerate progress forthe most vulnerable children. These statistics go far beyond
mere numbers. The human despair and lost opportunities
represented in these numbers demand children everywherebe given the basic services, protections and opportunities
they need to survive and thrive.
See the Complete End of Childhood Index, Country Rankings
and an explanation of the methodology, beginning on page 31.

Beating the odds in India
Anika has been attending the Save the Children’s Mobile
Learning Center for three years. Prior to that, she was
not in school because her life had been disrupted. Her
mother left the family and was working in the sex trade.
Her family had to leave the mother’s family home andAnika and her sister took responsibility for cleaning thehouse, washing clothes and cooking all the meals.  
A member of the center’s team identified Anika andpersuaded her to visit the center. After attending fora year, they convinced her father to let her go backto school and helped her enroll. Anika still goes to thecenter for help with her homework. She loves school.
Her favorite subject is science and she wants to be ascience teacher when she is older.
Anika is also a member of a children’s group set up by
Save the Children to campaign for child rights. Her focus
is on preventing child marriage. When she hears about achild marriage being planned, she and a group of otherchildren approach the parents and the couple. They
explain the harm child marriage can do and educate thegirl on her rights. Anika is very proud that she managed
to stop a friend’s sister’s marriage recently.
Photo: CJ Clarke / Save the Children

Anika, age 12, is a successful campaigner
against child marriage in Kolkata.

END OF CHILDHOOD REPORT

5

This slum community in Mumbai, India surrounds the Deonar
landfill site – the biggest dumping ground in Asia. Many parents
in these slums work in the garbage dump, sorting and sellingrubbish. Very few children have the opportunity to go to school.

Photo: Souvid Datta / Save the Children

THREAT #1

PovertyChildren raised in poverty start life at a big disadvantage. Being poor means
more than just not having money – it means material, social and emotional
deprivation, as well as impoverished living conditions and less access to services.
Poverty creates obstacles to children’s survival, development, protection andparticipation in decisions that affect their lives.
Children are more likely to be poor than adults, and theyexperience poverty differently than adults. Being raisedin poverty negatively impacts healthy development andlearning and increases exposure to risk. These effects canlast a lifetime, and be passed on to the next generation.
A quarter of the countries in the End of Childhood Index arecharacterized by widespread poverty (47 of 185 countries).25
But child poverty exists in all contexts, from the poorest
fragile states to the richest and most equal societies. Nearly
20 percent of children in developing countries – an estimated
385 million children – live in extreme poverty.26 Roughly thesame number live in moderate poverty, bringing the global
total to at least 750 million. And untold millions more areliving on the streets, in institutions, in urban slums and on themove, where they are invisible in household surveys. Then
there are some 30 million children living in severe relative
poverty in OECD countries,27 including more than 6 million
children living in deep poverty in the United States.28
The world’s poorest children (those in extreme poverty)
are concentrated in rural areas (81 percent). Most live in
sub-Saharan Africa (52 percent) and South Asia (36 percent).
India alone is home to 30 percent. Children in conflict-affected
countries are at greatest risk of poverty.29 Nearly 6 in
10 children in fragile contexts live in extremely poor
households. Worldwide, members of minority ethnic groups,
indigenous people, children with disabilities, and those whoare migrants, born to immigrants or single mothers, tend
to experience greater levels of poverty.30
Many of these children are missing out on childhood, notbecause they are poor but because they are almost certain
to be denied a fair start in life. Children from the poorest
households experience worse health, including higher rates
of malnutrition and death. They struggle to access decent
education and, if they are in school, to stay there and toachieve minimum learning standards. Poor children are
also much more likely to be involved in child labor, tomarry as children and to start childbearing early.
No matter where they live, children living in poverty are

exposed to threats of all kinds, including exploitation andabuse. They frequently experience bullying and discrimination,
especially at school, which causes anxiety, frustration andanger. Children around the world express feelings of shame,
insecurity and hopelessness. In wealthier countries, poor
children report stigma and social exclusion around receiving
free school meals, having dirty or “uncool” clothes, not having
the latest gadgets, lacking money to join school events andother peer group activities, or feeling unable to invite friends
to visit overcrowded or sub-standard housing.31

Photo: Hedinn Halldorsson / Redd Barna

Living on the streets
Kinfe*, left, and Fiker*, right, both 12, are among
thousands of children who live in and around the
Merkato bus station in Addis Ababa, Ethiopia. “I havebeen living on the street for four years,” says Kinfe.
“Today, we’ll go to this nearby hotel at 2:30 p.m. That’s
when they throw out some food. Normally we search
for food in trash bins. Sometimes we find enough.
Sometimes we don’t.”

END OF CHILDHOOD REPORT

7

THREAT #1
The effects of poverty can last a lifetime and beyond.
Deficiencies in childhood lead to stunted development,
low levels of skills needed for life and work, limited future
productivity as adults, and transmission of poverty down
to the next generation. In fact, evidence shows the health,educational and social status of one’s parents – especiallythe mother – is key to determining a child’s life chances.32
Even in wealthy countries, children brought up in poverty
are likely to remain poor and raise their own children inpoverty.33 That’s why tackling inequity and ensuring equal
opportunities for all children is vital to ending extreme
poverty by 2030 and ensuring every last child, regardlessof parental background, can reach his or her full potential.

POOR HEALTH AND DEATH
Every day, more than 15,000 children die before reaching
their fifth birthday, mostly from preventable or treatablecauses. A large, and growing, share of them are newborn
babies in the first month of life (46 percent). Global action
in recent decades has improved coverage and quality ofmaternal and child health care – including immunizations,
treatment of pneumonia, diarrhea, malaria and otherdiseases. This remarkable progress has saved 50 million
children’s lives since 2000. But progress is not happening
fast enough to reach SDG targets in most of the world’s
poorest countries.34
Today, child deaths are increasingly concentrated incountries with the fewest resources. Low- andlower-middle-income countries now account for 90 percent of
all under-5 deaths, but only 65 percent of all births. This is up
from 79 percent of child deaths in 1990.35
Children from the poorest households are, on average,
twice as likely to die before the age of 5 as children fromthe richest households.36 According to data tabulated by
Save the Children, some of the greatest survival gaps arefound in East Asia, where the poorest children are 3 to 10
times as likely to die before age 5 as their wealthiest peers.37
Large disparities are present in Mongolia, Thailand andVietnam – all countries that have already reached the SDG
target of 25 or fewer deaths per 1,000 live births at thenational level, but not among the poorest children.
High-income countries also have large equity gaps in childsurvival. The 75,000 children who die annually in developed
regions come disproportionately from disadvantaged
backgrounds and communities. In many European countries,
for example, the Roma community lives largely in poverty
and their children face lower odds of survival. Data are scarce,
but suggest the child mortality rate in Roma communities isaround 3 times higher than the general population.38 And
in the United States and Canada, infants from indigenous
communities die at higher rates – 40 percent higher than
the national average in the U.S.39 and 20 to 360 percent
higher than the rest of Canada.40
In most regions, child mortality rates have declined
substantially faster for the poorest than for the richest
households since 2000. As a result, equity gaps are closing. But
they are not closing fast enough. No region is on track toCharlmanta, 8 months
old, suffered chronicmalnutrition and was
at risk for stunted
growth. After three
weeks of treatment
he has started to gain
weight and is now more
active and playful.

Photo: Save the Children Philippines

8

SAVE THE CHILDREN

THE POOREST CHILDREN ARE TWICE AS LIKELYTO BE STUNTED AS THE RICHEST
PoorestRichestPercentage of children under 5 who are stunted,
by wealth quintile and by region, 2016

70

60

2.0 times
higher thanrichest52
50

2.4 times
higher thanrichest46

2.2 times
higher thanrichest2.1 times
higher thanrichest2.2 times
higher thanrichest44

45
4.3 times
higher thanrichest30

30

1.6 times
higher thanrichest24
20

25

2.4 times
higher thanrichest

18
19

44

42

40

20

2.2 times
higher thanrichest

19

21

20

Least
developed
countries

World

16
10
7

7

0
South Asia

West &
CentralAfricaEast Asia &the Pacific*

Eastern &Southern
AfricaLatin
Middle East
America& North& theAfricaCaribbean**

EasternEurope &CentralAsia***

Note: This analysis is based on a subset of 92 countries with recent (2011-2017) data by wealth quintile groupings covering 69 percent of the global population.
Regional estimates are presented only where adequate population coverage (≥50 per cent) is met. *East Asia and the Pacific does not include China, **Latin
America and the Caribbean does not include Brazil and ***Eastern Europe and Central Asia does not include the Russian Federation.
Source: UNICEF <data.unicef.org/topic/nutrition/malnutrition/#> (accessed 25 March 2018), based on Multiple Indicator Cluster Surveys (MICS), Demographic and
Health Surveys (DHS) and other nationally representative surveys.

close its child mortality equity gap by 2030, and most will notachieve equity in under-5 mortality rates between the poorest
and richest households even by 2050. In sub-Saharan Africa,
equity gaps are actually growing because under-5 mortality
has declined faster for richer households.41
Closing gaps between rich and poor would save millionsof young lives. In 2016 alone, some 2 million lives would havebeen saved had under-5 mortality in the poorest households
been as low as it is in the wealthiest households. Closing the
gap between countries would produce even more dramatic
results. If all countries had at least the same under-5 mortality
as the average rate of high-income countries (5.3 deaths per
1,000 live births) nearly 90 percent of all under-5 deaths could
be averted, meaning almost 5 million children’s lives could
have been saved in 2016 alone.42

MALNUTRITION THAT CAUSES STUNTING
Globally, 155 million children under age 5 suffer fromchronic malnutrition – also known as stunting, or low height
for age. Much of this damage happens in pregnancy and thefirst two years of a child’s life. Stunting prevents children
from developing to their full potential mentally andphysically, and it is largely irreversible. While the End ofChildhood Index examines stunting, the kind of malnutrition
that permanently impairs a child’s development, stunting
is not the only form of malnutrition that affects children
living in poverty. Some 52 million children are acutely
malnourished, of which 17 million have severe acutemalnutrition, the most serious form that can kill in justa few days. Overweight children are also an increasing
cause of concern, and many poor countries now face
the twin challenges of undernutrition and obesity. 43
Stunting is caused by, and contributes to, vicious
intergenerational cycles of poverty. Mothers who areundernourished are more likely to have small babies andundernourished children. Stunted children often perform
poorly in school and drop out earlier than their betternourished peers, limiting their future earnings. This type of
malnutrition diminishes not only the futures of individuals,
but also of nations.
In nearly every region of the world, children from the
END OF CHILDHOOD REPORT

9

THREAT #1

CHILDREN OUT OF SCHOOL
Today more than ever, education remains the key toescaping poverty, while poverty remains the biggest
obstacle to education. In developing countries, many of thepoorest children never get a chance to go to school. And
in all countries, students who live in poverty go to school
unprepared for success because they are behind theirclassmates physically, socially, emotionally or cognitively.

ACHIEVING QUALITY UNIVERSALPRIMARY AND SECONDARYEDUCATION COULD CUT GLOBAL
POVERTY RATES IN HALF
Estimated effect of universal secondary education
completion on poverty headcount
1,000

Poverty headcount (millions)poorest families are more than twice as likely to be stunted
as children from the wealthiest. Equity gaps are greatest
in Latin America and the Caribbean, where stunting rates
among the poorest are 4 times those of the richest. In Belize,
Haiti, Honduras and Mexico, the poorest children are closer
to 5 times as likely to be stunted as their wealthiest peers.
In Nicaragua, they’re 6 times as likely to be stunted. And
in Peru, they’re 11 times as likely to be stunted (rates are
32 vs. 3 percent). Equity gaps are also great in Angola,
Vietnam, Jordan and Iran, where relative ratios are
7, 7, 8 and 17, respectively.44
The rich-poor stunting gap is unchanged or increasing inmost low-income countries. An analysis of 54 countries withcomparable trend data between around 2000 and around2014 shows that gaps between the poorest 20 percent andrichest 20 percent of children under 5 are closing in the
majority of upper-middle-income countries. However, inalmost all low-income countries (24 of 27 with available trenddata), this gap has either remained the same or increased.45
Chronic malnutrition is becoming concentrated in countries
with the fewest resources, where 1 in 3 children have stunted
growth. Today, 9 in 10 stunted children (139 million children)
live in low- and lower-middle-income countries.46 This
proportion is up from 7 in 10 in 1990.
New research suggests that in addition to setbacks inphysical growth, 1 in every 3 preschool-aged children living
in low- and middle-income countries (LMICs) – more than
80 million children – are failing to meet basic milestonesin their cognitive and/or socio-emotional development.47
Taken together, the study’s authors estimate that roughly
half of all 3- and 4-year-old children in LMICs are failingto meet their development potential.

800

600

400

Lifted out ofpoverty
Poor

Remainingin poverty

200

0

-55%

In low- andmiddle-income countries...if all adults completed
secondary education

Source: UNESCO UIS and EFA Global Education Monitoring Report.
Reducing Global Poverty Through Universal Primary and Secondary Education.
(2017).

Many children from impoverished families do not attend
school because their parents cannot afford school fees orother costs for uniforms, books and supplies. The expenses
may be too much for a family to pay, on top of the money
the family loses by not sending a child to work or evenmarrying off a daughter. Especially in rural areas, long
distances between home and school can also be an obstacle
to education because of transportation cost, time awayfrom other duties at home, or danger of attack.

“I like math and English. I want to be a doctor because I want tohelp people who are sick. But my mother cannot afford to pay
for school. I feel bad because the other kids go to school. I readbooks I get from my neighbors who go to school.” – James, age 12, Uganda
10

SAVE THE CHILDREN

Poor children with disabilities are one of the most excluded
groups. Surveys in over a dozen low- and middle-income
countries have shown that children with disabilities are
significantly less likely to be in school than their peers without
disabilities.48 In fact, by one estimate, around 90 percent
of children with disabilities in developing countries do notattend school.49
Children in low-income countries are almost 9 times as
likely to be out of school as those in high-income countries.
About 33 percent of school-aged children in low-income
countries are out of school, compared to less than 4 percent
in high-income countries.50
Poorer countries not only tend to have higher out-ofschool rates, they also tend to have larger absolute numbersof out-of-school children. Today, 84 percent of all out-ofschool children live in low- and lower-middle income countries,
up from 69 percent in 1990 and 77 percent in 2000.51
In the majority of countries with data, economic disparities
in primary school attendance have narrowed – with thegreatest gains among children from the poorest quintile.52
However, the wealth gap remains large in a number ofcountries, and in some, the gap has even grown. The largest
disparities are in West and Central Africa, where children ofprimary school age from the poorest wealth quintile are on
average 6 times as likely to be out of school as those fromthe richest (primary out-of-school rates are 54 percent vs.
9 percent, respectively).53
Alarming disparities are also seen in learning outcomes.
Data reveal significant gaps in children’s learning performance
between the richest and poorest households. In almost all
countries, children from the richest households are far more

likely to achieve minimum learning standards in reading thanthose from the poorest households.54 The same is true ofmathematics, where children in the poorest households
systematically record lower test scores than children in
the richest households.55 In high-income countries, thelargest achievement gaps in learning between the best-off
and worst-off students are consistently found in France,
Hungary and Luxembourg.56
Universal secondary education could cut global poverty
in half. A quality education provides knowledge, skills and selfconfidence that increase children’s future productivity and wage
earnings and makes them less vulnerable to risks. A UNESCO
study estimated that if all children completed primary andsecondary school, more than 420 million people could lift
themselves out of poverty, thereby reducing the number ofpoor people worldwide by more than half.57 The effects would
be particularly large in sub-Saharan Africa and Southern Asia,
where almost two-thirds of the reductions would be expected.

CHILD LABOR
The global number of child laborers has declined by close
to 40 percent since 2000, but an estimated 152 million
children are still trapped in child labor, compelled to work
to support themselves and their families. Almost half,some 73 million children, are doing hazardous work that
directly compromises their physical, mental, social and/or educational development. 58
Children working to support their families don’t just missout on education. They also miss out on rest, play andrecreation. They lose opportunities to participate in their

Photo: Nour Wahid / Save the Children

Working insteadof studying
Sultan*, age 11, has the
responsibilities of a full-grownadult. He left school before helearned to read and write inorder to work and support his
mother and three sisters. He goesaround the streets of villages
in Lebanon selling packs ofchewing gum and boxes of tissues.
He doesn’t return home before
he has secured the $5 his familyneeds, even if that means staying
on the street until midnight.

END OF CHILDHOOD REPORT

11

THREAT #1“I think children work because they have to, because they are poorand they make them do it. Children don’t like to work, and it’s notnormal to have children work.” – Resul*, a Roma boy displaced from Kosovo to Montenegro
community, religion, cultural activities and sports. The loss ofthese rights means that, in effect, many working children missout on their childhood.
In the world’s least developed countries, 1 in 4 children
are engaged in child labor.59 Compare this to just 1 percent
in high-income countries. Africa is home to nearly half of
all child laborers globally (72 million). Asia and the Pacificaccounts for another 40 percent (62 million).60
Within countries, poor children are much more likely
to be forced into work than their wealthier counterparts. An
analysis of disaggregated data shows the poorest children
are, on average, 3 times as likely as their wealthiest peers to
be engaged in child labor. In Nepal and Togo, child labor rates
among the poorest children are 5 times those found among
the wealthiest. In Vietnam, the poorest children are 8 times
as likely to be working, and in Mongolia the rate is 9 times
as great.61
Child labor is not limited to poorer households or
low-income countries. More than half of all child laborers(84 million) live in middle-income countries and 2 million
live in high-income countries. These statistics make clearthat while poorer countries require special attention,
the fight against child labor will not be won by focusing
on poorer countries alone.62

CHILD MARRIAGE
Child marriage is most common in the world’s poorest
countries and is often concentrated among the poorest
households within those countries. In families with limited
resources, child marriage is often seen as a way to provide
for their daughter’s future. But girls who marry young are
more likely to be poor and to remain poor.
Child brides are frequently deprived of their rights to health,education and safety. They are at higher risk of experiencing
dangerous complications in pregnancy and childbirth. They
are frequently isolated and feel disempowered. And they arevulnerable to sexually transmitted infections and multiple
forms of violence.
Ending child marriage could save developing countries
trillions of dollars by reducing fertility and population growthand improving earnings and child health. Child marriage not
only affects the lives of millions of girls, it also has a huge
impact on the economy. According to first-ever estimatesfrom the World Bank and the International Center for
Research on Women, by 2030, global gains from ending
12

SAVE THE CHILDREN

child marriage could reach more than $500 billion per year.
These effects would be felt by the poorest countries andhouseholds in particular. The economic gains from ending
child marriage in Niger could reach $1.7 billion annually by
the year 2030, solely from the effects of reducing fertility.
In Ethiopia, the benefit would be $4.8 billion, while in Nepal
it would be almost $1 billion. In Bangladesh, ending childmarriage could generate close to $4.8 billion annually in
additional earnings and productivity. In Nigeria, the annual
economic cost of child marriage as a result of lost earnings
and productivity could be up to $7.6 billion. In Pakistan,
it could reach $6.2 billion annually.63

ADOLESCENT BIRTHS
Teen pregnancy is a global challenge, affecting richand poor countries alike, but birth rates are highest
in resource-poor settings. In sub-Saharan Africa, theadolescent birth rate is more than twice the global
average, while Latin America and the Caribbean has
the next highest rate.64
Around the world, adolescent pregnancies are more likely
to occur in marginalized communities, commonly driven bylack of education, unemployment, gender inequality, lack ofsexual and reproductive health services, and the low status of
women and girls.65 In the United Kingdom, for example, girls
from poor families are 8 times as likely to give birth young
as those from wealthier backgrounds.66 And in Cambodia,
37 percent of girls aged 15-19 with no education are alreadymothers or pregnant with their first child, compared to
8 percent of girls with secondary or higher education.67
The poorest girls have about 3 times as many births as thewealthiest.68 In all but two countries with available data, thepoorest girls are more likely to begin childbearing early.
Equity gaps are greatest in Bolivia, Indonesia, Nigeria andPeru, where girls in the bottom wealth quintile are about
6 times as likely to give birth in adolescence as girls in the
top quintile. Nigeria also has the largest absolute gap: thefertility rate for the poorest girls is 214 births per 1,000 girls –one of the highest rates found anywhere in the world –compared to 37 per 1,000 girls among the wealthiest. Other
countries with especially large relative gaps include Armenia,
Azerbaijan, Colombia, Dominican Republic, India, Philippines
and Senegal, where poor girls aged 15-19 are 4 to 5 times as
likely as their wealthiest peers to give birth.

Photo by Jonathan Hyams / Save the Children

Young, poorand parenting
Brissa, 15, with her
3-month-old sonin Sinaloa, Mexico.
Teenage pregnancy isvery common in thisagricultural area, where
76,000 migrant farmworkers come eachyear to harvest corn,
potatoes, cucumbers
and tomatoes.

Adolescent pregnancy can have negative economic
consequences on girls, their families and communities andcosts countries billions of dollars each year. An estimated10 to 30 percent of girls who drop out of school do so
because of early pregnancy or marriage, depending on the
country. Because of their lower educational attainment, manyadolescent mothers have fewer skills and opportunities for
employment, often perpetuating cycles of poverty. Nationally,
this can also have an economic cost, with countries losing out
on the income that young women would have earned overtheir lifetimes had they not had early pregnancies.
According to new research by the World Bank, the benefitsof ending all early childbirths (those occurring both within
and outside of child marriage) could exceed $700 billion peryear by 2030. Cumulatively, for the period from 2014 to 2030,
the welfare gains from ending child marriage and earlychildbirth could be more than $5 trillion.69

Preventing unintended pregnancy is essential to improving
adolescents’ sexual and reproductive health and their socialand economic well-being. Legal reforms, education, mass
media and role models can drive changes in social norms,
improve the status of girls, and challenge ideas about malesexual entitlement and impunity. For example, Stepping Stones
life-skills training programs in Africa and Asia have had
success in developing stronger, more equal relationships
between males and females.70
About half of pregnancies among adolescent girls aged
15 to 19 living in developing regions are unintended, andmore than half of these end in abortion, often underunsafe conditions. Meeting the unmet need for modern
contraception would reduce unintended pregnancies
among this age group by 6 million annually. That would
mean averting 2.1 million unplanned births, 3.2 million
abortions and 5,600 maternal deaths.71“We were very poor – sometimes we would eat every two or threedays. Even though my parents really wanted all three of theirdaughters to study, it wasn’t possible, so they got me married.”– Lucky, age 15, Bangladesh
END OF CHILDHOOD REPORT13

A man and his child walk throughthe rubble, having survived anairstrike in Eastern Ghouta, Syria.

## SAVE
THE
CHILDREN/ Save the Children
Photo:
Amer
Almohibany

THREAT #2

Armed Conflict
Children are more at risk in armed conflict now than at any time in the last
20 years.72 There are at least 240 million children living in countries affected byconflict and fragility,73 and they are often denied their rights to health, education,
protection and freedom from fear.
Suffering violence, witnessing violence or fearing violence
can cause lifelong disabilities and deep emotional trauma.
Separation from family members and economic hardshipcan expose girls and boys to exploitation in the forms ofchild labor, child marriage, sexual violence and recruitment
into use by armed groups.
But the less visible dangers for children in conflict arecaused by lack of food and the collapse of essential services
such as health care, sanitation and education. The loss ofbasic necessities required for a fulfilled childhood threatens
both the immediate survival and long-term future of children.
Conflict also tends to exacerbate economic and genderinequalities in poor countries, making a bad situation evenworse for the most vulnerable children.
According to new research by the Peace Research Institutein Oslo, the most dangerous countries for children in conflictare: Afghanistan, Nigeria, Somalia, Syria and Yemen. The study
also found that denial of humanitarian access has increased
15-fold in recent years.74

POOR HEALTH, MALNUTRITION AND DEATH
Of all the children under 5 who die worldwide, more than
1 in 5 live in fragile states – a total of 1.2 million deaths in
2016. This share has almost doubled since 1990.75 The major
causes of death in these settings are largely preventable
and treatable: pneumonia, diarrheal diseases, malaria andmeasles. But these illnesses claim more children’s lives
because the health care and nutritious food that could
save them is unavailable or out of reach due to insecurity.
The first day of life is the most dangerous day for anyone,
anywhere.76 But in conflict settings, the risks to mothers andnewborns can multiply due to lack of skilled care, medicines
and unsanitary conditions.
While the rest of the world is making good progress in
reducing child mortality, conflict-affected countries are fallingbehind. The five countries with the world’s highest under-5
mortality rates are all fragile and conflict-affected: Chad,Central African Republic, Mali, Sierra Leone and Somalia. If
current trends continue, none of these countries will achieve

MOST CHILD DEATHS IN
CONFLICT AREAS ARE CAUSEDBY MALNUTRITION, DISEASE
AND LACK OF HEALTH CARE
Malnutrition, disease and inadequate health care killmore children in war zones than bombs or bullets.
Growing numbers of children now live in countries
affected by fragility and conflict, where they face nearly
twice the risk of dying before their fifth birthday as
children in non-fragile contexts.
1.5%
98.5%

Deathsdue toall othercausesDeaths directly
attributed to conflict
and terrorism

Under-5 deaths in fragile andconflict-affected settings, 2016**Includes the estimated number of under-5 deaths in 34 of 36 fragile andconflict-affected states, as classified by the World Bank Group for FY2018.
Data were not available for Kosovo or Tuvalu. Data source: Institute for
Health Metrics and Evaluation (IHME), Global Burden of Disease Study 2016.
Note: There are currently no comprehensive, reliable data on childcasualties in conflicts. It is not known exactly how many children were
killed in conflict-related incidents in Central African Republic, South Sudan,
Syria and Yemen and many other countries in 2016. This means countlesschildren are dying unnoticed by the international community, and thenumber of deaths directly attributed to conflict and terrorism shown inthis graphic is likely an underestimate.

END OF CHILDHOOD REPORT

15##

THREAT #2“I feel a pain in my heart when I think about Myanmar and thehouses that were burnt and our relatives that were killed. We
don’t have any money now. I don’t want to live like this. I amvery worried about the future.” – Rajuma*, age 13, Cox’s Bazar, Bangladesh

Displaced from homewith nothing to eat“The violence started early in the morning,” said
Malika. “The homes in my village were burned andwe lost everything we had. So I left with my children
and nothing else, and moved around from onepart of the bush to another.”
Malika’s husband was declared missing in action.
“It’s just me and the children now,” she says.
Malika and her children are among more than
13 million people in Democratic Republic of theCongo’s Kasai region in need of aid this year. The
complex humanitarian situation is the result of
decades of conflict, compounded by new rebellions
and political tensions.
“The children were losing a lot of weight and theirfeet started to swell,” she explained, as they weretreated at a hospital supported by Save the Children.
“The care we’re receiving here is good and we’reseeing an improvement.”

the SDG target for child survival reduction by 2030, andonly one (Sierra Leone) will reach the target by 2050.77
Malnutrition is an underlying cause in almost half of childdeaths each year,78 with rates of both chronic malnutrition(which causes irreversible stunting in children) and acutemalnutrition (which causes wasting and increased risk ofmortality) especially high in fragile and conflict-affected
settings. The proportion of people who are undernourished isabout 2.5 times higher in countries in conflict and protracted
crisis than in countries not affected by conflict.79
Chronic malnutrition has also become increasingly
concentrated in conflict-affected countries. Recent researchby the International Food Policy Research Institute found thatover the past two decades, the number of stunted children in
conflict-affected countries in the developing world increased
from an estimated 97.5 million (46 percent of all stunted
children in developing countries) to 112.1 million(65 percent).80 More recent estimates by FAO put the
number of stunted children living in countries struggling
with conflict, violence and fragility at 122 million – morethan three-quarters of the global total in 2016.81
While few would question that peace and stability
generally improve prospects for children’s nutrition, there
is some evidence that the reverse may also be true – goodnutrition and food security may enhance prospects for peaceand stability. More research is needed to better understandhow poor nutrition and food insecurity influence conflict andthe extent to which these may be causes as well as effectsof violence. For example, child malnutrition rates have beenfound to be 50 percent higher, and under-nutrition rates
45 percent higher, at the point when conflict breaks out incountries.82 Available evidence also suggests investing infood and nutrition resilience promotes more stability
and less unrest.83

CHILDREN OUT OF SCHOOL
Photo: Mike Sunderland / Save the Children

Malika*, with her three children: Tina*, 11, Ray*, 5, Mina*,
1, in Saint Joseph Hospital, Kasai Oriental, DR Congo.

16

SAVE THE CHILDREN

Violent conflict severely disrupts access to education.
In many countries, including Iraq, Libya, Nigeria, Sudan,
Syria and Yemen, schools, teachers and students have beentargeted for attack. 84 Schools have also been occupied bymilitary and armed groups, making them unsafe for children.
Often as a result, schools are closed or parents remove
their children for fear of violence, including sexual violence.

“I was in school before we moved here”
Photo: Sussan Akila / Save the Children

Falmata* hasbeen out of school
since her family
fled violence innorthern Nigeria
when she was 12.

A May 2017 assessment in Syria showed that dangers
traveling to and from school, lack of teaching staff, destroyed
facilities, lack of materials and long distances between
home and school were the primary reasons children did
not attend.85 In a July-August 2017 survey, more than
80 percent of Syrian communities reported that child labor
was preventing school attendance.86
A large – and growing – share of the world’s out-of-school
children live in conflict-affected countries, where progressin education has been slowest.87 In 2012, 36 percent of theworld’s out-of-school children were living in conflict-affected
countries, up from 30 percent in 1999.88 Children who missschool during episodes of armed violence tend not to go
back.89 As a result, many conflict-affected countries are thefurthest away from achieving global education goals. Only
4 of 34 fragile or conflict-affected states with available data
(Burundi, Kiribati, Myanmar and Sierra Leone) have achievedor nearly achieved universal primary education.90 It is difficult
to determine exactly how many displaced children and youth
are denied access to schooling, but estimates suggest at least
27 million children are out of school due to conflict.91
Disruption of schooling is compounded in many conflictaffected contexts by displacement from home. While education
is available in some refugee camps, it is often disorganized,“We were displaced three years ago when ourvillage was raided,” says Falmata. “Our houses
were burned down. Many people were killed, but
my whole family escaped.”
As they were beginning to rebuild their lives ina new location, both of Falmata’s parents died,leaving the three children to fend for themselves.
“A man came and said he loves me. He wasgiving me some money. I needed to support myfamily, so I was collecting the money. It wasn’t much[about a dollar or less each time]. When I realized I
was pregnant and informed him, he stopped coming
to see me. I was so scared. I didn’t know what to do.
“One day, a lady came to the house and told me
she works for Save the Children. She took me to thehospital and registered me for prenatal care. Anytime I have to go to the hospital, she will come andtake me there. She has been so supportive. I talkto her any time I feel unhappy. She told me I canenroll back in school after delivery. I am looking
forward to that because I want to be able tosupport myself and the baby as well. I want tobecome a good mother.”

temporary, under-resourced, overcrowded and limited toprimary education.92 Children often cannot access schools
outside camps for reasons of security, lack of documentation,
restrictions on the movement of certain population groups,
cost related to education (e.g., for uniforms, school fees, school
lunches, books, transportation) or the lack of language skills
needed to participate in schools in new locations. For example,
about two-thirds of refugees live in areas where none of theofficial languages is the official language in their country oforigin.93 Xenophobia and stigmatization are also challenges
for many refugee children who miss out on education.
Refugee children are 5 times more likely to be out ofschool than non-refugee children. UNHCR estimates that,in 2015, over 60 percent of refugee children (some 3.7 of
6 million child refugees of school-going age) were out ofschool. More than half of these out-of-school refugee children
are found in just seven countries: Chad, Democratic Republicof the Congo, Ethiopia, Kenya, Lebanon, Pakistan andTurkey.94
Without education, displaced children face bleak futures.
Especially in times of crisis, education can offer a child stability,
protection and the chance to gain critical knowledge andskills. Schools can also serve as social spaces that bring
together family and community members, and create bonds
END OF CHILDHOOD REPORT

17

THREAT #2
of trust, healing and support. Failing to provide education
for displaced children can be hugely damaging, not only forchildren but also for their families and societies, perpetuating
cycles of poverty and conflict.

CHILD LABOR
There is a strong correlation between child labor andconflict. The incidence of child labor in countries affected byarmed conflict is 77 percent higher than the global averageand the incidence of hazardous work is 50 percent higher.95
Children in conflict-affected countries are often removed
from school to contribute to household income, replace lost
household labor (due to recruitment, deaths or injuries)
or to help with additional household burdens.
Adolescents are at great risk, as secondary education is along-term investment whose benefits can be difficult to see fora family that has lost everything. It’s difficult for many refugee
families to avoid sending adolescents out to earn a wage
through child labor, even more so if keeping them in school
would present additional financial burdens.96“I didn’t want to get married”
Maha, a Syrian refugee living in Jordan, was forced tomarry her husband when she was 12. She is now one
month pregnant.
“I didn’t want to get married.” She said. “I am still
young and I wanted to finish my studies.”“She was going to register for school, but there
were a lot of rapes going on in the camps,” says Maha’shusband. “Her father was scared something like thatwould happen to her. Also, he was struggling with bills
and rent, so he went ahead and married her off.”
Photo: Rosie Thompson / Save the Children

Maha*, age 13, with her 23-year-old husband.
18

SAVE THE CHILDREN

Child labor has been identified as a major barrier toeducation in many countries currently experiencing conflictor recently emerging from conflict, including Colombia,
Democratic Republic of the Congo, Pakistan, Sri Lanka andTajikistan.97 It is also reportedly on the rise for both Syrian
refugee children and host communities.98 In Jordan, forexample, a recent survey of the resident child population(which included migrants and refugee households) found childlabor rates have roughly doubled compared to pre-crisis
figures.99 Similarly, there is anecdotal evidence of a risein child labor in Yemen as families struggle to survive.100
Child labor has risen in sub-Saharan Africa, a region thathas been particularly hard hit by conflict. In fact, all but oneof the nine countries with “very high” child labor rates(defined as prevalence at or above 40 percent) are in
Africa and seven of the nine are current or former fragile
and conflict-affected states.

CHILD MARRIAGE
Conflict makes girls more vulnerable to child marriage.
The reasons for child marriage vary greatly, depending on
the context, but most of them are based in situations that
become worse during conflict. Fear of rape and sexual
violence, of unwanted pre-marital pregnancies, of family
shame and dishonor, of homelessness and hunger or
starvation have all been reported by parents and children
as reasons for early marriage. In some instances, childmarriage has been used to facilitate migration out of
conflict-affected countries and refugee camps.101 In others,
it has been used by armed groups, as a weapon of war.102
Child marriage is reportedly on the rise for girls in Syria
and among Syrian refugee populations.103 Marriage ofchildren under 18 years old is not a new phenomenon in
Syria. However, with the protracted nature of the crisis, childmarriage has evolved from a cultural practice to a coping
mechanism. Families arrange marriages for girls, believing
marriage will protect them and also to ease financial burdens
on the family. According to gender-based violence experts,
this trend increased in 2017 and girls are being marriedat younger ages.104 Among Syrian refugees in Jordan, forinstance, the share of registered marriages involving girls
under 18 years of age rose from 12 percent in 2011, to
18 percent in 2012, 25 percent in 2013 and then 32 percent
in early 2014.105 In Lebanon today, over 40 percent of young
displaced Syrian women were married before 18.106 There
have been similar reports of increases in child marriage
among Syrian refugees in Egypt, Iraq and Turkey.107
Child marriage rates have risen in Yemen as the conflict has
intensified. It is one of the few countries in the world without
a legal minimum age of marriage, and more than two-thirdsof girls are now married before they reach 18, compared tohalf of girls before the conflict escalated.108
Child marriage is also a growing concern among refugees
from Myanmar109 and Central African Republic.110

Rania*, age 10, fled
violence in Myanmar.
Her father was killed
and she was shot in
the leg. She is now
orphaned and lives with
her aunt in Bangladesh.

END OFRoupell
CHILDHOOD##
Photo: Antonia/ SaveREPORTthe Children

Fifteen-year-old Aisha* does household chores with her daughter
Rayan*, age 2, in the small home where she lives in Somalia. “At
the age of 13, I was forced to marry a man who was much older
than me,” says Aisha. “I tried to run away several times, but every
time, my father would return me to him. While I was pregnant, he
tried to beat me, and then I left him for good.”## SAVE
THECrowley
CHILDREN
Photo:Colin/ Save the Children

THREAT #3

Discrimination Against GirlsA girl born today has far greater advantages than she would have had decadesago. She has a much better chance of reaching her fifth birthday. She is less likely
to be stunted and more likely to go to school. But far too many girls, especiallythose from the poorest families, still face discrimination and exclusion withrespect to basic education, child marriage, early pregnancy, sexual violence andunrecognized domestic work.111
Thirty percent of countries in the End of Childhood Index
are characterized by discrimination against girls (55 of
185 countries).112 This means staggering numbers of girls
worldwide face exclusion on many fronts. Complications
during pregnancy and childbirth represent the number one
killer of girls aged 15-19 worldwide, and 12 million girls
marry each year before they reach the age of 18.113 Yet boys,
too, face exclusion. Boys, for example, have much higher
rates of homicide than girls, and they are more likely to be
involved in hazardous work.
Most countries characterized by conflict are also characterized by discrimination against girls (23 of 34 countries).114
There are over 85 million girls living in these countries.

GIRLS OUT OF SCHOOL
The worldwide gender gap in education is narrowing. Of the
263 million children and youth (aged 6 to 17) who were outof school in 2016, there was a nearly even split between girls
and boys.115 But despite efforts made and progress achieved,
significant gender disparities persist at younger ages and incertain parts of the world.
Out-of-school girls are a diverse group, held back bybarriers related to cultural norms, poverty, early and forced
marriage, teen pregnancy, rural residence, refugee conditions,gender-based violence, disability and other causes. Threequarters of out-of-school girls live in sub-Saharan Africa andSouth Asia. Early marriage is one of the most common causesof low educational attainment of girls in these regions. In Latin
America and the Caribbean, child labor has been identified
as the most significant reason that children withdraw fromsecondary education.116 An estimated two-thirds of girls who
are out of school worldwide are from ethnic minority groups
in their countries.117 In Lao PDR, for example, Hmong girls
are 3 times as likely to be out of primary school as girls
belonging to the majority Lao ethnic group.118
Girls are more likely than boys to never set foot in aclassroom. At last estimate, some 15 million girls of primaryschool age would never get the chance to learn to read or
write in primary school compared to about 10 million boys.
Over half of these girls – 9 million – live in sub-SaharanAfrica.119
In addition to sub-Saharan Africa, stark disparities persist in
the Middle East and parts of South Asia. In sub-Saharan Africa,
only 92 girls are enrolled in school (primary + secondary) for
every 100 boys. The ratio is 94 per 100 in Arab States. The
greatest gender gaps are found in Afghanistan, Angola, Somalia
and South Sudan. In these countries, there are fewer than
7 girls enrolled in school for every 10 boys.120
Regional averages often mask large disparities at thecountry level. South Asia, for example, has achieved gender
parity as a whole; however, girls are disadvantaged in somecountries but advantaged in others. Bangladesh, India and
Nepal now have many more girls than boys in school. But inneighboring Pakistan, there are still only 8 girls enrolled forevery 10 boys.
Conflict, poverty and other forms of social disadvantage
magnify gender disparities in education. Girls living in countries
affected by conflict, for example, are 2.5 times more likely to
be out of school than boys.121 Girls in low-income countries
are also significantly more likely to be out of school than boys.
In most sub-Saharan African countries, girls from the poorest
households are the most disadvantaged of all in terms ofschool participation. If current trends continue, these girls are
not expected to achieve universal lower secondary completion
until 2111.122
The effect of overlapping disparities is illustrated on page 23.
Across the set of 79 countries with recent data, the poorest
girls are, on average, 6 times as likely to be out of primaryschool as the wealthiest boys.123 In Nigeria, the country withthe largest absolute disparity, nearly 75 percent of the poorest
girls are out of school, compared to only 5 percent of thewealthiest boys.
END OF CHILDHOOD REPORT

21##

THREAT #3“It is more difficult for girls. For boys it is easier. Because
when you go shopping you get harassed by boys. You arethen not allowed to go to the shops or anywhere else.”– Nour, age 14, Za’atari refugee camp in Jordan

Her journey to become a Golden Girl
Photo: Save the Children Bangladesh

Parul overcame intellectual disability andgender discrimination to win gold medals
for Bangladesh in the Special Olympics.

22

SAVE THE CHILDREN

Parul comes from a poor family that struggled toget by. Even before her disability was discovered,
she was neglected within her family because she
is a girl. At mealtime, her brother got more food,and she became malnourished. When she was5, a local group supported by Save the Children– Bangladesh Protibondhi Foundation (BPF) –identified Parul’s mild intellectual disability, andher family was even less interested in sending her
to school. People in the community blamed Parul’s
mother for giving birth to such a girl, and hermother feared divorce.
BPF worked with the family and the community
to raise awareness and change attitudes about
the rights of children with disabilities. They also
provided support to the family to help improvetheir income.
When Parul started school, she showed astrong interest in games and sports, especiallyswimming. BPF arranged for her to practice inthe local pond and Save the Children supported
her participation in national and internationalswimming competitions. She won a bronze medalin the Special Olympics in Greece in 2011, thengold medals in 2013 in Australia and 2015 in
the USA.
Parul continued her studies and completed
her primary education. She is now in secondary
school. Her mother says: “Before, I was known
as a mother of a lunatic girl, but now people knowme as the mother of a girl who achieved a gold
medal. I am very grateful to Save the Children
and BPF.” Parul’s father is also proud: “Now I am
not just a van driver, I am Parul’s father.”GIRLS ARE ESPECIALLY DISADVANTAGED WHERE POVERTYAND GENDER DISPARITIES COMBINE
100

90

Poorest girls
Country average
Wealthiest boys

80

Primary out-of-school rate (%)

70

60

50

40

30

20

10

0

Nigeria

GuineaMali

Burkina
Faso

Pakistan

Niger

Benin

Sudan

South
Sudan

Yemen

Out-of-school rates for primary-school-aged children overall, girls from the poorest households and boys
from the richest households.
Note: Chart includes the top 10 countries with the greatest difference (i.e., absolute gap) between out-of-school rates for the poorest 20 percent of girls comparedto the wealthiest 20 percent of boys out of 79 countries with disaggregated household survey data from 2010-2016. Source: UNESCO Institute for Statistics, 2018

UNRECOGNIZED DOMESTIC WORK
While most estimates show little-to-no gender gap interms of involvement in child labor, gender disparities areobserved in the types of work activities children do. Boys
are slightly more likely to work in agriculture and industry,
while girls are more likely to work in services, especiallydomestic work. Girls and boys can also be assigned to very
different tasks even when working in the same workplace,thereby exposing them to unique risks and hazards. On
a fam­ily farm, for example, boys often bear greater
responsibility for operating ma­chinery, using sharp tools,
and spraying chemicals. Girls, on the other hand, often
play a role in hauling water and carrying wood.

Girls are much more likely than boys to shoulder
responsibility for household chores. They account for twothirds of all children who perform household chores for atleast 21 hours per week, the threshold beyond which researchsuggests chores begin to negatively impact the ability ofchildren to attend and benefit from school. Girls are also more
likely than boys to perform “double work duty,” meaning
both work in employment and in household chores.
Parents’ decisions are often influenced by wider social norms
about the different roles that girls and boys should play in thehome and in society. For example, in some communities, girls
are more likely to be kept at home to help with chores andcare work. In Andhra Pradesh, India, girls spend nearly anhour and a half more each day on domestic work than boys.

END OF CHILDHOOD REPORT

23

The dangerous walk
for water“The hardest part about being a girl is going to thewell to get water,” says Robina, age 9. Like most girls inrural Uganda, she has to go to a distant well every day
to fetch water for her family. And every day she faces
the threat of violence, and even death, along the way.
Young girls can spend as many as six hours a day
fetching water, and they are easy prey when they travelalone – at risk of assault, trafficking and even murder.
Robina lost her best friend, who was taken, tortured
and killed while fetching water alone near her school.
Save the Children is working to help communities
protect young girls like Robina. One effort is a simple“buddy system” where girls are encouraged to always
travel in pairs. Another program enlists parents andothers to act as crossing guards to protect commuting
students.

Photo: Rick D’Elia / Save the Children

Robina (right) and her friend Charity collect water together inWakiso, Uganda. Robina had another friend who lost her life
while fetching water alone.

In Ethiopia and India, caring for siblings is a primary reason
why girls drop out of school early.124

CHILD MARRIAGE
More than 80 percent of children married before age
18 are girls. Child brides tend to be poor, under-educatedand living in rural areas.125 Girls living in countries facing
humanitarian crises are often most vulnerable of all to childmarriage.126 (For more on this, please turn to page 18.)
Many factors interact to place a girl at risk of earlymarriage. Poverty, weak laws and enforcement, the perceptionthat marriage will provide “protection,” family honor, customs
24

SAVE THE CHILDREN

or religious laws that condone the practice, and unequal
gender norms that prioritize women’s roles as wives, mothers
and family caretakers are all major drivers of early marriage.
The prevalence of child marriage is decreasing globally.
The most progress in the past decade was seen in South Asia,
where a girl’s risk of marrying before her 18th birthday
dropped from nearly 50 percent to 30 percent, in largepart due to the lower child marriage rate in India. Still, an
estimated 12 million girls marry in childhood each year.
And without further reductions, more than 150 million
more girls will marry before their 18th birthday by 2030.127
Sub-Saharan Africa is now home to close to 1 in 3 of thesechild brides, compared to 1 in 5 a decade ago.128 Across theregion, child marriage rates are not declining fast enoughto keep up with population growth. This is especially true inWest and Central Africa, where it will take over 100 years
to end child marriage at the current rate of progress.129
The global number of adolescent pregnancies is also up,
and 90 percent of births to girls aged 15-19 occur within
marriage. Adolescent birth rates are declining, but because
the global population of adolescents continues to grow,projections indicate the number of adolescent pregnancies
will increase globally by 2030, with the greatest proportional
increases in West and Central Africa and Eastern andSouthern Africa.130
Nearly 100 million girls are not protected by national laws
against child marriage and at least 7.5 million marry illegallyeach year – that’s 20,000 per day. In most countries, childmarriage is prohibited by national law. But many countries
still allow girls to be married before 18 if their parents orjudicial bodies give consent. Research by the World Bankand Save the Children found that at least 70 percent ofchild marriages were illegal under national law even after
accounting for parental or judicial consent.131
Most child marriages take place in low- and lower-middleincome countries, but it happens in high-income countries too.
In the United States, for example, well over 200,000 children
under 18 were married between 2000 and 2015. The majorityof them were girls and most married adult men. Some wereas young as 12 and 13 years old. These girls come fromdiverse backgrounds: urban and rural, poor and well-off,white and non-white, multigenerational U.S. citizens andrecent immigrants, religious and non-religious families.132

VIOLENCE AGAINST GIRLS
It is estimated that 1 in 3 women globally have experienced
physical or sexual violence in their lifetime, mostly at thehands of their partners.133 Types of violence experienced
by a girl may include: prenatal sex selection (feticide –removal of the female fetus), female infanticide, neglect,
female genital mutilation, rape, child marriage, forced
prostitution, honor killing and dowry killing.
Rape, sexual assault and forced prostitution, sometimes
under the disguise of “marriage,” are gross violations ofhuman rights and have been used as weapons of war acrossTHREAT #3“I was married at 14 and it was very hard. I had to drop out of school.
I was really sad and scared. I had to move to a new village where I
did not know anyone.” – Fatima, age 23, Senegal
all continents, from Syria to Afghanistan to Myanmar,
Colombia and Central African Republic.134
Children escaping war and persecution are particularly
vulnerable to becoming victims of trafficking. Girls andboys are both affected, but twice the number of girls arereported as trafficking victims.135 While girls tend to be
trafficked for forced marriages and sexual slavery, boys
are typically exploited in forced labor or as soldiers.136
While both boys and girls can be the target of sexual
violence, data suggest girls are generally at a heightenedrisk. Around 120 million girls worldwide (slightly more than
1 in 10) have experienced forced sex or other forced sexualacts at some point in their lives.137 Still, the suffering of boys
who experience sexual violence must not be overlooked,
especially in certain parts of the world where it’s moreprevalent. The majority of cases of sexual violence againstchildren in Afghanistan, for example, relate to boys.138
Certain forms of cultural violence – such as dowryrelated abuse and acid throwing in Bangladesh, India andPakistan, for example – only affect girls and women, andcarry lifelong health consequences, or even result in death.
Adolescence is a period of pronounced vulnerability,
especially for girls. In Bangladesh and Cameroon, morethan 20 percent of adolescent girls aged 15 to 19 reporthaving experienced forced sex.139 Rates above 10 percent
are reported in 11 other countries: Central African Republic,
Democratic Republic of the Congo, Equatorial Guinea,
Gabon, Ghana, Jordan, Liberia, Malawi, Rwanda, Tanzania
and Uganda.
In five European countries (France, Luxembourg,
Netherlands, Spain and United Kingdom), more than
1 in 10 young women report experiencing at least one
incident of sexual violence by an adult perpetrator
before age 15.140
Girls with intellectual disabilities are particularly
vulnerable, with up to two-thirds experiencing sexual abuseby age 18.141 Children with disabilities in general are
disproportionally vulnerable to violence, neglect and abuse.
One systematic review of 17 studies from high-income
countries found children with disabilities to be 3 to 4 times
more likely to be victims of violence than peers without
disabilities.142 However, studies from across the globe showthat girls with disabilities are at increased risk compared tothose without disabilities and with boys with disabilities.143“When I refused,
he took me by force.”

Denise* wasraped when
she was 15 andgave birth to ason she named
Innocent.

Alessandro Pavone / Save the Children

Denise’s mother runs a “house of tolerance” in the
Democratic Republic of the Congo, which is like a barthat offers sexual services. From a young age, Denise
served alcoholic drinks to her mother’s customers.
When she was 15, she came home from school one
day and was left alone in the house with a man. “Heasked me to have sex with him, and when I refused,
he took me by force … I became pregnant.”
Denise and her baby son lived with the man until
she had a stillbirth when she was 7 months pregnant
with her second child. That was 5 months ago and the
man abandoned her afterwards. Alone and hungry,
Denise eventually returned to her mother. Both she
and Innocent were malnourished and she also hadtuberculosis. Innocent is 17 months old now, and has
developmental problems caused by his malnutrition.
Save the Children helped Denise and Innocent
overcome malnutrition and Denise is now part of an
income-generation program. She also receives emotional
support and guidance from counselors trained by
Save the Children.

END OF CHILDHOOD REPORT

25

Photo: Tommy Trenchard / Save the Children##

SAVE THE CHILDREN

These children participate in a
Save the Children-supported nutritionand education program in Nigeria.

Recommendations
In September 2015, world leaders came together and agreed on an ambitious
global framework for ending poverty called the 2030 Agenda for Sustainable
Development, which includes 17 Sustainable Development Goals. The SDGs
promise a future in which all children have a full childhood – free from malnutritionand violence, with access to quality health care and education – and reinforces
obligations to children set out in the UN Convention on the Rights of the Child.
Most importantly, this is a future in which no child is left behind.
This year’s End of Childhood Report report again demonstrates
that we are far from realizing the vision where all children
survive and thrive. Children continue to be excluded fromprogress, especially those children living in marginalized,
vulnerable populations. In addition, the report highlights
how governments need to address further exclusion ofchildren due to three threats – conflict, poverty and gender
discrimination – if the world is going to achieve theSustainable Development Goals, and reach them in an
equitable way. Disabled children are especially vulnerable,
especially when disability is combined with one or moreof the threats highlighted in this report.
We call on world leaders to value children and their rightto survive, thrive and be protected by following through on thecommitments made under the SDGs, and by taking immediate
steps to implement the pledge to leave no one behind. This
pledge is a commitment to ensure that these goals and targets
are met for all nations, all people and all segments of society,and to ensure that the furthest behind are reached first.
This will require governments to make three key guarantees
to children:•

Investing in children – To achieve the SDGs and ensurethat all children have access to universal quality basic
services (especially education and health), including
protection and social protection services, governments(including donors) need to raise the necessary resources.
Governments must ensure these resources reachexcluded children, particularly girls and refugees, in
keeping with the focus on public investment in children
outlined by the UN Committee on the Rights of theChild. Improved public investment in excluded children
must go hand in hand with the removal of cost barriers

to services and measures to ensure minimum financial
security for all children through child-sensitive social
protection. Country governments, with support fromdonor governments, should increase domestic resource
mobilization (DRM) – where countries raise and spend
their own funds for long-term sustainable finance.
This can be done by building efficient tax systems andmobilizing public resources. Country governments should
move towards a tax-to-GDP ratio of 20 percent andensure local citizen engagement in the DRM dialog.

•

Ensuring all children are treated equally – Enddiscriminatory policies, norms and behaviors suchas preventing girls from accessing health services or
denying education to a child because of ethnicity or
gender. To facilitate children’s access to quality services,
governments must also put in place systems to register
every child at birth. This includes providing functionalchild protection systems that include all children in all
settings, including homes.

•

Counting and including all children, regardless of
who they are or where they are from – Governments
must ensure that all children, especially excluded
children, are counted in data that are used to measureprogress on the SDGs. Data should be collected anddisaggregated by age, economic group, sex, race,
ethnicity, disability and geography or migratory status,and be reported publicly in accessible formats. Data
must be collected on disabled, indigenous and othermarginalized populations to close equity gaps. In
addition, excluded children – girls and boys – should
participate in policy-making and budgeting, and be
END OF CHILDHOOD REPORT

27

supported to monitor progress and hold governments
to account. Governments and donors must also invest in
improved data, as there is a significant void in availabilityof data, especially data for the groups mentioned above.

Photo: Sukaina Sharafuddin / Save the Children

In addition to these cross-cutting global guarantees, specificactions are needed to address poverty, conflict and gender,
with a focus on girls and children who are refugees.

THREAT #1 – POVERTYAs shown in this report, poverty is a key barrier to ensuringchildren survive and thrive. Children experience poverty indifferent ways than adults do. Child poverty has been more
specifically described as “deprivation of the material, spiritualand emotional resources needed for children to survive,
develop and thrive, leaving them unable to enjoy their rights,
achieve their full potential or participate as full and equal
members of society.”144
Therefore, action must be taken to address child poverty:•

All countries should adopt a National Action Plan
to reduce and eliminate child poverty, together withdedicated budgets and monitoring systems that track
improvements in poverty-related deprivations among
girls and boys of all ages.

•

All governments should ensure that children in poverty(and their families) benefit from Universal Social
Protection measures, such as child grants, and should
expand programme coverage as quickly as possible
to reach all children who are poor.

•

As malnutrition is both a result and a cause of poverty,
donor and country governments must close the financing
gap that is needed to reach globally agreed nutrition
targets, such as reducing stunting, reducing anemia, andincreasing the rate of exclusive breastfeeding throughstrengthening and/or developing strong national
financing plans that address inequities and leveraging
the Global Financing Facility to include specific objectives
to address nutrition in country investment plans.

•Countries and donors need to include a focus on reachingadolescent girls with nutrition-specific interventions in
national and donor nutrition plans. This includes investingin research to understand how to reach adolescents,
particularly girls.

THREAT #2 – ARMED CONFLICTAn increasing number of children are affected by conflict,which has long-term effects on a child’s ability to survive
and thrive. Donor governments must address the needs ofchildren affected by conflict. Specifically they should focus on:

28

SAVE THE CHILDREN

Every girl deserves an education
Batool, age 10, had to flee her hometown in Yemen
because of the conflict, but she’s keeping up with herstudies and enjoying activities at a child-friendly space
run by Save the Children in Hayel. Despite her losses,
she looks forward to a bright future.

Development and protection:•

Donors should fulfill their commitments in the World
Humanitarian Summit Grand Bargain agreement for
multi-year funding for protracted crises to allow flexible
programming that can address the underlying causesof conflict and improve health and other indicators.

•

All states and armed actors should abide by theircommitments or obligations under International
Humanitarian Law, and endorse and implement the Paris
Commitments and Paris Principles. Non-state armed
actors should sign and implement the “Geneva Call”
Deed of Commitment for the protection of children
from the effects of armed conflict.

•Donors should increase investment in protection,
mental health and psychosocial services, and educationin emergencies. Currently less than 5 percent of
humanitarian funding goes to these sectors.

Guarantee education:•

Donors and governments should provide financial
support and access to a quality education for children
affected by conflict.

•Donors and non-state armed actors should endorse
and implement the Safe Schools Declaration to prevent
education from coming under attack.

•Governments and donors should work together toensure refugee children are in a learning program
within 30 days of crossing a national border.

THREAT #3 – DISCRIMINATION AGAINST GIRLS
As this report illustrates, gender inequality is pervasive incountries across the world, placing poor and marginalized
girls at particular risk of being left behind. Save the Children
is campaigning against this, with a particular focus on
ending child marriage – an issue that strikes to the heartof the gendered discrimination that is holding girls back,undermining their rights to survive, learn and be protected.
We are calling for:••Countries and donors to invest in achieving genderequality, including increasing spending and monitoringbudgets designed to close gender gaps. This must include
ensuring girls are able to complete their education –including those children who may have been forced toleave school because they are married or pregnant –and that they are safe from sexual and gender-based
violence.
Countries to raise the legal age of marriage to age 18,
close legal loopholes, implement costed action plans,
and address harmful norms that leave girls vulnerable tochild marriage and other forms of gender-based violence.

•

Governments and international bodies to establish
strong global, regional and national accountability
mechanisms to monitor progress towards ending
child marriage, including the systematic gatheringof data on child marriage in humanitarian crises.

•

Donors to invest in girl-sensitive education programs
to ensure more refugee girls go to school and stayin school, and to improve refugee girls’ access to
education by removing economic barriers (throughinitiatives such as scholarships, free access andtransport) and other key push factors, thus reducing
the likelihood of early marriage.

•

Donors to also increase support to host governments– including funding, technical support and capacity
building – to better enable them to address the issueof child marriage in host communities and refugee
camps. This includes strengthening the implementationof legal frameworks and procedures related to earlymarriage, and involving government actors in prevention
campaigns on early marriage.

•

Increase efforts to reach adolescent girls with sexualand reproductive health services including access tosex education. Sexual and reproductive health services,
especially for adolescent girls, need to be embedded innational budgeted health plans.

Saved from child marriage

Photo by Chris de Bode / Save the Children

Masa* is now 16 and has her sights set on university.

Masa and her family fled the war in Syria when she
was 11. They arrived in Jordan and she began attending
school, but then she started receiving marriage
proposals and was excited by the idea of getting
married because that’s what many of her friends were
doing. She dropped out of school and began preparing
for her wedding.
Save the Children found out about her plans and tried
to change her mind. She refused to do so on their firsttwo visits, asking them to leave. But on the third visit,
she listened to what they had to say. “They told me
about the risks and disadvantages of early marriage,”said Masa. “They told me if I didn’t get married now andcompleted my education, I would be able to build myown future. I liked what they said and understood it.
“Then I started to compare what they said with thelives of my married friends. When I sat down with oneof them, she said that she wished time could go backand I shouldn’t accept to get married. I decided not
to get married and went back to school.
“Right now I want to continue my education and
go to university, and I want to become president.”

END OF CHILDHOOD REPORT29

A young girl helps her father plant millet
near their home in Niger.

Photo: Jonathan Hyams / Save the Children

2018 End of Childhood Index Rankings
RANK
1
1
3
3
5
6
6
8
8
8
11
12
12
14
14
16
17
17
19
19
19
22
22
24
25
25
27
28
28
28
31
32
33
34
35
36
37
38
39
40
40
42
43
43
45
46
47
48
48
50
51
52
53
54
54
54
57
58
58

COUNTRY
Singapore
Slovenia
NorwaySwedenFinland
IrelandNetherlands
IcelandItaly
Republic of Korea
Portugal
CyprusGermany
FranceSpain
Belgium
Australia
Switzerland
IsraelJapan
Luxembourg
Denmark
United Kingdom
CanadaLithuania
PolandGreeceCroatia
Estonia
New ZealandLatviaHungary
Malta
Bahrain
Belarus
United States
Russian Federation
KuwaitBosnia & Herzegovina
China
Qatar
United Arab Emirates			G
Oman
UkraineKazakhstan
SerbiaSaudi Arabia			G
Bulgaria
Tunisia
LebanonC		G
JordanMaldives			G
Montenegro
Mauritius
Romania
Tonga			GArmenia
Chile
Samoa

SCORE
987 ∧
987 ∧
985
985 ∧
984 ∧
981 ∧
981 ∨
980 ∧
980 ∧
980 ∧
979 ∨
978
978
977 ∧
977 ∧
976 ∨
975 ∧
975 ∧
973 ∧
973 ∨
973
971 ∨
971
970
968 ∨
968 ∧
967 ∨
965 ∨
965 ∨
965 ∧
963 ∧
962
961 ∧
956
952 ∧
945 ∧
944 ∧
943 ∧
941 ∨
939 ∧
939 ∨
936
932 ∧
932 ∨
930 ∨
928
927 ∧
925 ∧
925 ∧
924
921 ∧
920
919 ∨
916 ∨
916 ∧
916 ∧
913 ∧
911 ∨
911 ∧

Few children missing out on childhood**
Some children missing out on childhood
Many children missing out on childhood
Most children missing out on childhood∧ Score is up from last year
∨ Score is down from last year
C Country is characterized by conflict/fragility
P Country is characterized by povertyG	Country is characterized by discrimination
against girls

RANK
60
61
61
63
64
65
66
67
68
69
70
71
72
73
73
73
76
77
78
79
79
81
82
82
84
85
86
87
88
89
90
91
92
93
93
95
96
97
98
99
99
101
102
102
104
105
106
107
108
109
110
111
111
113
114
115
116
117
118

COUNTRY
Sri Lanka
BahamasBarbados
Cuba
TurkeyAlgeria
TfYR Macedonia			 GMalaysia
Brunei Darussalam
Costa Rica
DPR Korea		 P
Mongolia
Georgia
Argentina
Fiji
Uzbekistan
Saint Lucia			G
Albania
Uruguay
Jamaica
Trinidad & Tobago
Moldova
Seychelles
Turkmenistan
State of PalestineC
Thailand			G
Iran			GSuriname
Morocco 			GAzerbaijan 			GCabo Verde
Egypt
Kyrgyzstan
BrazilMexicoPeru
Vietnam
Tajikistan 			GBhutanEcuadorParaguay
BelizeBotswana
VanuatuPhilippines
Indonesia 			GPanamaMyanmar*C
GuyanaGabon
Namibia
Nicaragua
South Africa 			GIndia 		 P GSwaziland		P
Sao Tome & Principe		 P
Bolivia
Rwanda		P
Colombia

SCORE
908 ∧
906 ∨
906 ∧
905 ∧
904 ∨
903
900 ∨
898 ∧
897 ∧
895 ∧
894 ∧
891 ∧
887 ∧
884 ∧
884 ∧
884 ∧
880 ∨
878 ∧
875 ∧
872
872 ∨
867
866 ∨
866 ∧
864 ∧
863 ∧
860
856 ∨
850 ∨
841 ∧
840 ∨
830
825 ∧
822 ∧
822 ∧
818 ∧
816 ∧
812
810 ∨
806 ∨
806 ∧
805 ∧
800 ∧
800 ∨
799 ∨
794 ∧
792 ∨
791 ∧
787 ∧
779 ∧
777
770 ∧
770 ∨
768 ∧
766 ∨
760 ∧
758 ∧
757
756 ∧

RANK
119
120
121
122
123
124
125
125
127
128
129
130
130
132
133
134
134
136
137
138
139
140
141
142
142
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
158
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175

COUNTRY
Cambodia			G
Ghana
El Salvador
Dominican Republic
Kenya		 P G
Haiti
C P
Djibouti
C		G
Iraq*
C		G
Congo
C PG
Timor-Leste		P
Venezuela
Bangladesh		P
Uganda		 P GLao PDR		 P
Solomon Islands
C PG
Comoros
C PG
Togo
C PG
Zimbabwe
C P
Papua New Guinea
C PG
Nepal		 P GSenegal		 P GSudan
CEthiopia		 P GBurundiC P
Syria*C
Honduras
Yemen*C PG
GambiaC PG
Zambia		 P GLiberia
C PG
Pakistan			G
Tanzania		 P GMalawi		 P GGuatemala			G
Eritrea
C PG
Côte d’Ivoire
C PG
Equatorial Guinea			G
Guinea-Bissau
C PG
Lesotho		P
Benin		 P GCameroon			G
Afghanistan
C PG
Madagascar		P
Mauritania
Angola		 P GMozambique
C PG
Burkina Faso		 P
DR Congo
C PG
Sierra Leone
C PG
Guinea		 P GNigeria		 P GSomalia
C PG
South Sudan
C PG
Chad
C PG
Central African Republic C P G
Mali
C PG
Niger		 P G

SCORE
752 ∨
749 ∨
747 ∧
740 ∨
737 ∨
734 ∧
730 ∧
730
719 ∨
718 ∨
716 ∨
701 ∧
701 ∧
690 ∧
688 ∨
687 ∨
687 ∧
685 ∧
681 ∧
677 ∨
668 ∨
667 ∧
663 ∧
656 ∧
656 ∨
651 ∧
648 ∨
646 ∧
633
631 ∨
630 ∧
622 ∨
620 ∧
619 ∨
613 ∧
611 ∧
609 ∧
608 ∧
605 ∨
594 ∧
594 ∧
592 ∨
589 ∧
585 ∨
579 ∧
572 ∨
560 ∧
556 ∨
553 ∧
524 ∨
513 ∨
483 ∧
475 ∨
424 ∨
421 ∨
420 ∧
388 ∧

Index scores reflect the average level of performance across a set of eight indicators related to child health, education,
labor, marriage, childbirth and violence. The only reason a country was not included in this analysis was insufficient data
(i.e., the country was missing values for three or more indicators). To see the underlying dataset, including data gaps, turnto pages 32-35. Performance bands reflect the extent to which children are missing out on childhood. For details, see
Methodology and Research Notes.
* 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, 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., UnitedStates, Russia).

END OF CHILDHOOD REPORT

31

Complete End of Childhood Index 2018
CHILDHOOD ENDER

CHILD DIESCHILD IS
SEVERELY
MALNOURISHED

CHILD IS OUTOF SCHOOL

CHILD BEGINSWORK LIFE

CHILDMARRIESCHILD HAS A
CHILD

INDICATOR

Under-5
mortality rate
(deaths per
1,000 live
births)Child stunting(% children
aged 0-59
months)Out-of-school
children ofprimary andsecondaryschool age (%)

Childrenengaged inchild labor(% ages 5-17)

Adolescentscurrently
married or inunion (% girls
aged 15-19)

Adolescentbirth rate
(births per
1,000 girls
aged 15-19)

Population
forcibly
displacedby conflict(% of total)

Child homicide
rate (deaths
per 100,000
population
aged 0-19)

2016

2012-2017+

2012-2017+

2012-2017+

2012-2017+

2015

2017

2015

70.4
13.5
25.2
82.5
8.5
11.1
13.4
3.7
3.5
30.9
10.6
7.6
34.2
12.3
3.9
3.9
14.9
97.6
32.4

40.9
23.1
11.7
37.6
…
8.2
9.4
2.0
…
18.0
…
…
36.1
7.7
4.5
…
15.0
34.0
33.6

41.8
8.5
…
36.4
19.4
2.7
5.7
2.1
…
4.6
11.2
2.6
18.4
5.5
1.7
1.9
9.2
23.8
19.0

29.4
5.1
5.0
23.4
…
4.4
8.7
…
…
6.5
…
…
4.3
1.9
1.4
…
3.2
52.5
2.9

x,y

x,y

19.7
6.5
3.1
18.2
…
12.7
4.6
0.5
2.7
8.9
2.4
5.3
44.2
2.4
7.5
2.2
20.8
16.0
15.2

36.9

18.1

11.8

26.4

x,y

6.0
40.6
15.1
9.9
7.6
84.6
71.7
21.4
30.6
79.7
4.9
123.6
127.3
8.3
9.9
15.3
73.3
54.1
8.8
91.8
4.7
5.5
2.6
3.2

8.9
31.4
7.1
19.7
…
27.3
55.9
…
32.4
31.7
…
40.7
39.9
1.8
8.1
12.7
32.1
21.2
5.6
21.6
…
…
…
…

…
…
8.3
9.5
7.9
40.1
25.9
20.5
22.5
22.6
2.7
49.1
49.1
6.9
7.6
7.7
27.4
10.3
5.3
33.4
6.3
8.1
3.0
…

5.3
9.0
6.6
…
…
39.2
26.3
6.4
19.3
47.0
…
28.5
51.5
6.6
…
7.8
22.0
23.3
4.1
31.3
…
…
…
…

x,y
x,y
y

Afghanistan*
Albania
Algeria
AngolaAntigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
BahamasBahrain
Bangladesh
Barbados
BelarusBelgium
BelizeBenin
BhutanBolivia(Plurinational State of)Bosnia and Herzegovina
Botswana
BrazilBrunei Darussalam
Bulgaria
Burkina Faso
BurundiCabo VerdeCambodia
Cameroon
CanadaCentral African Republic
Chad*
Chile
China*
Colombia
Comoros
Congo*
Costa Rica
Côte d’Ivoire
Croatia
Cuba
CyprusCzech Republic
Democratic People’s
Republic of Korea
Democratic Republicof the Congo*
DenmarkDjibouti
Dominican Republic

SAVE THE CHILDREN

x
x

x

x

x
x
x

x

x

x
a

z

x

x

x
x

z
z

x,z

x,y
y

y
y

y
y
y
y

x,y
x,y
y
y

x,y
y
y
y
x,y
a

71.2
21.8
10.5
161.9
43.9
63.8
22.5
13.8
6.8
61.0
28.7
13.4
82.6
39.4
17.6
8.1
65.1
81.8
20.2

14.2
1.1
0.0
0.1
0.1
0.0
0.8
0.0
0.0
6.4
0.1
0.0
0.0
0.1
0.1
0.0
0.1
0.0
1.3

11.6

70.4

0.7
…
3.9
…
8.4
31.5
8.6
8.1
15.6
20.1
2.2
54.9
38.3
5.7
3.1
13.3
16.4
16.1
9.0
18.4
2.0
15.8
3.1
0.9

8.2
31.0
66.7
20.8
36.8
107.2
27.9
73.2
52.2
102.4
9.5
90.7
129.8
47.5
7.3
48.7
67.1
116.1
56.0
135.6
9.2
45.1
4.9
9.7

20.0

27.9

1.8

x

…

0.3

94.3

42.6

18.1

z

38.4

21.3

4.4
64.2
30.7

…
33.5
7.1

3.8
52.9
15.2

Shading reflects prevalence: Moderate High Very high

32

x

…
7.7
12.8

x,y

3.5
4.2
27.5

x
x
a,b
a

CHILD IS A VICTIM
OF EXTREME VIOLENCE

x
a
b,x
x
a,x
x
b,x
a,b

x
a
a
x

b,x
x
x
x
x
a
a
x
x
a
x
b
a
a
a
x
a
x
x
b,x

x
b,x
a

Score
Rank
(out of 1,000) (out of 175)

2.0
1.4
1.8
3.8
1.4
2.0
0.3
0.3
0.3
0.9
6.7
0.2
1.6
6.2
0.6
0.4
11.1
2.3
0.7

592
878
903
579
–
884
913
975
–
841
906
956
701
906
952
976
805
594
810

160
77
65
163
–
73
57
17
–
89
61
34
130
61
35
16
101
158
98

0.0

6.4

758

116

4.9
0.0
0.0
0.0
0.0
0.0
7.1
0.0
0.1
1.0
0.0
25.1
1.1
0.0
0.0
16.0
0.2
1.9
0.0
0.3
0.8
0.1
0.0
0.0

0.7
2.2
18.6
0.2
0.4
4.9
2.5
2.8
0.9
5.0
0.8
4.9
4.8
2.5
0.5
22.1
2.2
3.0
3.4
3.7
0.2
1.4
0.2
0.1

941
800
822
897
925
560
656
840
752
594
970
421
424
911
939
756
687
719
895
611
965
905
978
–

39
102
93
68
48
165
142
90
119
158
24
173
172
58
40
118
134
127
69
154
28
63
12
–

0.5

0.0

122.3

5.8

4.0
21.2
97.3

0.0
0.3
0.0

c

END OFCHILDHOOD
INDEX 2018

c

e
c

c

2.5

894

70

6.7

556

166

0.4
2.2
11.8

971
730
740

22
125
122

COMPLETE END OF CHILDHOOD INDEX 2018
CHILDHOOD ENDER

CHILD DIESCHILD IS
SEVERELY
MALNOURISHED

CHILD IS OUTOF SCHOOL

CHILD BEGINSWORK LIFE

CHILDMARRIESCHILD HAS A
CHILD

INDICATOR

Under-5
mortality rate
(deaths per
1,000 live
births)Child stunting(% children
aged 0-59
months)Out-of-school
children ofprimary andsecondaryschool age (%)

Childrenengaged inchild labor(% ages 5-17)

Adolescentscurrently
married or inunion (% girls
aged 15-19)

Adolescentbirth rate
(births per
1,000 girls
aged 15-19)

Population
forcibly
displacedby conflict(% of total)

Child homicide
rate (deaths
per 100,000
population
aged 0-19)

2016

2012-2017+

2012-2017+

2012-2017+

2012-2017+

2015

2017

2015

20.9
22.8
15.0
90.9
44.5
2.9
58.4
22.0
2.3
3.9
47.4
65.3
10.7
3.8
58.8
3.8
16.0
28.5
89.0
88.1
32.4
67.0
18.7
5.2
2.1
43.0
26.4
15.1
31.2
3.6
3.6
3.3
15.3
2.7
17.6
11.4
49.2
54.3
8.4
21.1

25.2
22.3
13.6
26.2
50.3
…
38.4
…
…
…
17.5
25.0
11.3
1.3
18.8
…
…
46.5
32.4
27.6
12.0
21.9
22.7
…
…
38.4
36.4
6.8
22.6
…
…
…
6.2
7.1
7.8
8.0
26.0
…
4.9
12.9

5.5
7.9
18.4
…
59.9
5.0
33.6
7.8
1.7
0.5
9.3
34.5
2.4
…
22.4
7.5
3.7
24.6
37.8
26.1
9.5
9.9
27.8
6.5
5.7
20.2
14.2
11.9
21.9
0.3
2.0
2.3
…
1.5
…
3.2
20.5
…
7.5
6.1

4.9
7.0
8.9
…
…
…
27.4
…
…
…
13.4
19.2
4.2
…
21.8
…
…
25.8
38.1
51.1
18.3
24.4
14.1
…
…
11.8
6.9
11.4
4.7
…
…
…
3.3
…
1.7
2.2
…
…
…
25.8

20.0
14.4
16.3
22.0
…
4.4
17.4
7.6
0.5
2.7
13.5
23.8
10.6
2.0
6.4
1.8
…
19.8
35.2
11.4
13.3
12.1
22.6
0.6
0.6
15.2
12.8
21.1
20.7
1.1
2.8
1.5
3.4
0.6
5.9
6.0
11.9
15.8
4.9
13.9

63.9

43.8

4.6
8.1
93.5
67.4
12.9
5.3
2.4
46.4
55.1
8.3
8.5

…
…
33.2
32.1
21.0
…
…
49.2
37.1
17.7
20.3

EcuadorEgypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
FinlandFranceGabon*
Gambia*Georgia
Germany
Ghana
GreeceGrenadaGuatemalaGuineaGuinea-Bissau*
GuyanaHaiti*
Honduras
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
IrelandIsraelItaly
JamaicaJapan
JordanKazakhstan
Kenya
Kiribati
KuwaitKyrgyzstan
Lao People’s
Democratic Republic
LatviaLebanonLesothoLiberia
Libya
Lithuania
Luxembourg
Madagascar*
MalawiMalaysia
Maldives*

x
x

x
x

a

x
x

x

x

x

x

x

z
z

z
z

x

x

18.8

10.1

5.1
20.1
24.7
46.9
…
3.1
8.4
28.6
17.5
13.7
1.6

…
1.9
…
20.8
…
…
…
22.9
39.3
…
…

x,z

x,z

y
y

x,y

y
x,y
y
y

y
a

y
y

x,y
x,y
x,y
x,y

x,y
y
x,y

x,y
x,y
x,y

y

x
b
a
x

a
b,x
x

x
x
a
x
a
a
a
a

a,b
b,x
b,x
x
b
x
x
b,x
b
a
a
x
b,x
a

24.8
2.6
3.3
17.7
14.3
…
2.1
1.0
33.7
23.5
6.0
5.0

x
b,x
a

x
x
x
a
b,x
b,x

75.6
51.3
64.9
107.5
53.0
12.4
56.6
45.2
6.4
8.8
97.7
112.5
38.3
6.4
66.1
7.2
29.6
80.1
139.6
87.5
87.6
38.9
64.3
17.7
5.7
23.3
49.2
26.3
84.8
10.1
9.3
5.9
58.8
4.0
22.6
27.2
90.2
16.4
9.4
39.2

CHILD IS A VICTIM
OF EXTREME VIOLENCE

0.1
0.0
1.7
0.0
10.7
0.0
0.2
0.1
0.0
0.0
0.0
1.6
7.6
0.0
0.1
0.0
0.2
0.4
0.4
0.2
0.1
0.9
2.5
0.0
0.0
0.0
0.0
0.2
13.6
0.0
0.0
0.0
0.1
0.0
0.1
0.0
0.0
0.0
0.0
0.1

c

3.3
2.8
20.9
0.9
2.4
0.5
3.0
1.2
0.6
0.4
2.5
4.7
1.5
0.5
4.8
0.4
0.5
16.1
4.7
5.4
5.4
10.7
28.9
0.3
0.0
1.0
1.8
1.2
6.1
0.3
0.8
0.2
10.1
0.2
1.0
0.9
2.3
4.3
0.8
1.9

END OFCHILDHOOD
INDEX 2018

Score
Rank
(out of 1,000) (out of 175)

806
830
747
609
613
965
663
884
984
977
779
646
887
978
749
967
–
619
524
608
787
734
651
962
980
768
794
860
730
981
973
980
872
973
921
930
737
–
943
825

99
91
121
155
153
28
141
73
5
14
109
146
72
12
120
27
–
152
168
156
108
124
144
32
8
113
105
86
125
6
19
8
79
19
51
45
123
–
38
92

63.7

0.1

3.9

690

132

13.3
12.2
93.2
107.1
6.2
10.4
5.7
114.8
135.3
13.7
6.2

0.0
0.2
0.0
0.2
5.0
0.0
0.0
0.0
0.0
0.0
0.0

0.8
1.7
8.7
4.1
0.9
0.6
0.1
5.5
0.4
1.0
1.2

963
924
605
631
–
968
973
589
620
898
920

31
50
157
148
–
25
19
161
151
67
52

Shading reflects prevalence: Moderate High Very high

END OF CHILDHOOD REPORT33

COMPLETE END OF CHILDHOOD INDEX 2018
CHILDHOOD ENDER

CHILD DIESCHILD IS
SEVERELY
MALNOURISHED

CHILD IS OUTOF SCHOOL

CHILD BEGINSWORK LIFE

CHILDMARRIESCHILD HAS A
CHILD

INDICATOR

Under-5
mortality rate
(deaths per
1,000 live
births)Child stunting(% children
aged 0-59
months)Out-of-school
children ofprimary andsecondaryschool age (%)

Childrenengaged inchild labor(% ages 5-17)

Adolescentscurrently
married or inunion (% girls
aged 15-19)

Adolescentbirth rate
(births per
1,000 girls
aged 15-19)

Population
forcibly
displacedby conflict(% of total)

Child homicide
rate (deaths
per 100,000
population
aged 0-19)

2016

2012-2017+

2012-2017+

2012-2017+

2012-2017+

2015

2017

2015

110.6
6.8
35.4
81.4
13.7
14.6
17.9
3.8
27.1
71.3
50.8
45.2
34.5
3.8
5.4
19.7
91.3
104.3
2.6
10.7
78.8
16.4
54.3
19.9
15.3
27.1
4.7
3.5
8.5
3.4
15.9
9.0
7.7
38.5
13.3

30.4
…
…
27.9
…
12.4
10.8
9.4
14.9
43.1
29.2
23.1
35.8
…
…
23.0
42.2
43.6
…
14.1
45.0
19.1
49.5
5.9
14.4
33.4
…
…
…
2.5
6.4
…
…
36.7
2.5

46.1
5.7
23.7
42.2
8.8
10.4
2.2
7.8
17.7
26.5
21.3
15.1
13.8
1.4
2.2
10.4
55.1
31.9
2.1
2.0
40.1
16.8
…
15.4
6.3
6.1
5.3
2.4
8.0
1.9
17.9
13.9
1.3
18.8
10.6

55.8
…
…
37.6
…
12.4
17.3
12.5
8.3
22.2
9.3
…
37.4
…
…
…
30.5
50.8
…
…
…
2.5
…
26.4
21.8
11.1
…
…
…
…
16.3
…
…
28.5
3.9

38.9
0.5
21.1
27.8
7.0
15.4
5.3
2.1
11.0
43.1
12.6
5.4
27.1
1.9
0.5
24.2
59.8
22.2
0.1
3.3
13.1
14.1
14.8
16.1
11.3
9.7
1.2
0.6
4.0
0.4
9.9
6.7
7.5
3.1
5.0

Mali
Malta
Marshall Islands
Mauritania
Mauritius
MexicoMongolia
Montenegro
MoroccoMozambique
MyanmarNamibia
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria*
NorwayOman
Pakistan
PanamaPapua New Guinea
Paraguay
Peru
Philippines
PolandPortugal
Qatar
Republic of Korea
Republic of Moldova
Romania
Russian Federation*
Rwanda*Saint Lucia
Saint Vincent
and the Grenadines
Samoa
Sao Tome and Principe
Saudi Arabia
SenegalSerbiaSeychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia*South Africa
South Sudan
Spain
Sri Lanka

SAVE THE CHILDREN

x
a

x
x
a

x

x

x
z

z
z
x

x,y
x,y
y

y
a

y
a
y
x,y

x,y

x,y
y

16.6

…

4.5

…

…

17.3
33.8
12.9
47.1
5.8
14.3
113.5
2.8
5.9
2.3
25.8
132.5
43.3
90.7
3.3
9.4

4.7
17.2
9.3
17.0
6.0
7.9
37.9
…
…
…
31.6
25.3
27.4
31.1
…
17.3

8.8
10.9
4.0
50.3
4.4
9.5
29.0
0.1
…
2.1
31.3
48.7
17.6
66.7
1.1
10.1

…
26.0
…
23.0
9.5
…
37.4
…
…
…
47.8
49.0
…
…
…
1.0

7.8
15.3
4.5
24.4
3.1
…
18.8
0.4
1.6
0.5
11.4
24.6
3.3
40.1
3.5
6.0

Shading reflects prevalence: Moderate High Very high

34

x
x

x

x
x

x

x
x,z

x

y

y
x,y

y

a
x
x
a,b
x
a
a
b,x
a
b
a
x
b,x
x
a
a,b
b
a
x
a
a
x
b,x
a,b
b,x
x
x
a

a
a
b,x
a

b,x
x
x
a
b,x
x
x
x
a

173.7
16.4
82.2
77.9
28.3
62.2
15.0
12.0
31.4
136.9
16.2
76.2
71.3
3.9
23.3
88.1
201.2
109.3
5.9
7.5
38.3
73.7
54.4
56.9
48.4
62.7
13.1
9.4
10.5
1.6
22.0
34.0
22.7
25.6
53.4

x,z

CHILD IS A VICTIM
OF EXTREME VIOLENCE

1.3
0.0
0.0
1.0
0.0
0.1
0.2
0.2
0.0
0.1
1.7
0.1
0.1
0.0
0.0
0.1
0.7
1.5
0.0
0.0
0.3
0.0
0.0
0.0
0.0
0.6
0.0
0.0
0.0
0.0
0.2
0.0
0.1
2.5
0.7

c

c

c

c

6.3
0.3
…
5.0
0.6
5.6
1.9
0.7
0.6
1.0
1.5
3.7
1.8
0.3
0.7
6.3
6.7
4.9
0.2
1.4
5.4
10.8
4.3
2.3
6.2
2.6
0.2
0.3
3.0
0.9
0.4
0.5
1.3
1.6
8.0

END OFCHILDHOOD
INDEX 2018

Score
Rank
(out of 1,000) (out of 175)

420
961
–
585
916
822
891
919
850
572
791
777
677
981
965
770
388
513
985
932
630
792
681
806
818
799
968
979
939
980
867
916
944
757
880

174
33
–
162
54
93
71
53
88
164
107
110
138
6
28
111
175
169
3
43
149
106
137
99
95
104
25
11
40
8
81
54
37
117
76

50.3

1.3

1.7

–

–

24.3
83.5
8.4
76.9
18.7
56.9
116.7
3.8
19.9
3.6
47.4
102.6
44.4
63.4
8.3
14.2

0.0
0.0
0.0
0.3
3.1
0.0
0.1
0.0
0.0
0.0
0.0
17.9
0.0
31.1
0.0
0.8

1.0
3.5
2.7
3.6
0.3
1.6
6.4
0.9
0.2
0.0
1.3
2.0
8.9
1.8
0.2
0.9

911
760
927
668
928
866
553
987
–
987
688
483
770
475
977
908

58
115
47
139
46
82
167
1
–
1
133
170
111
171
14
60

d

c
c

COMPLETE END OF CHILDHOOD INDEX 2018
CHILDHOOD ENDER

CHILD DIESCHILD IS
SEVERELY
MALNOURISHED

CHILD IS OUTOF SCHOOL

CHILD BEGINSWORK LIFE

CHILDMARRIESCHILD HAS A
CHILD

INDICATOR

Under-5
mortality rate
(deaths per
1,000 live
births)Child stunting(% children
aged 0-59
months)Out-of-school
children ofprimary andsecondaryschool age (%)

Childrenengaged inchild labor(% ages 5-17)

Adolescentscurrently
married or inunion (% girls
aged 15-19)

Adolescentbirth rate
(births per
1,000 girls
aged 15-19)

Population
forcibly
displacedby conflict(% of total)

Child homicide
rate (deaths
per 100,000
population
aged 0-19)

2016

2012-2017+

2012-2017+

2012-2017+

2012-2017+

2015

2017

2015

7.4
38.2
8.8
25.5
…
…
27.5
26.8
10.5

13.7
14.0
15.8
21.8
0.8
6.1
45.0
10.9
13.7

5.7
24.9
4.1
7.3
…
…
4.0
10.0
8.3

x,y
x
x,y

9.3
21.2
11.8
4.0
0.4
0.4
9.7
13.2
14.1

12.5

x,y

4.3

x

17.3

0.4

0.5

900

66

7.7
12.7
4.6
4.4
1.2
7.1
6.0
8.0
19.9
6.4
6.7
2.9

x

a
b
a,b
a
b,x
a
b,x
x

45.5
92.1
14.9
30.8
6.8
26.8
16.0
…
108.9
23.4
30.1
13.9

0.0
0.1
0.1
0.0
0.0
0.1
0.0
0.0
0.4
4.6
0.0
0.0

3.1
3.9
0.9
12.1
0.6
0.9
1.2
…
4.2
0.5
0.8
0.7

718
687
916
872
925
904
866
–
701
932
936
971

128
134
54
79
48
64
82
–
130
43
42
22

23.0

a

117.7

0.0

2.6

622

150

5.8
7.4
4.9
11.3

x
a
x
a

21.2
55.8
17.6
42.7

0.0
0.0
0.0
0.0

2.5
3.7
0.6
0.6

945
875
884
800

36
78
73
102

79.1

0.3

26.9

716

129

a
b

39.1
60.7
87.9
108.9

0.3
10.5
0.0
0.4

1.5
2.6
2.5
3.0

816
648
633
685

96
145
147
136

122.0

2.0

4.2

600

–

State of Palestine
19.4
Sudan*
65.1
Suriname
20.0
Swaziland
70.4
Sweden2.9
Switzerland
4.1
Syrian Arab Republic
17.5
Tajikistan
43.1
Thailand
12.2
The former Yugoslav
12.2
Republic of Macedonia
Timor-Leste
49.7
Togo*
75.7
Tonga
16.4
Trinidad and Tobago*
18.5
Tunisia*
13.6
Turkey12.7
Turkmenistan
51.0
Tuvalu25.3
Uganda*53.0
Ukraine9.1
United Arab Emirates
7.7
United Kingdom
4.3
United Republic
56.7
of Tanzania*
United States of America
6.5
Uruguay
9.2
Uzbekistan
24.1
Vanuatu
27.6
Venezuela
16.3(Bolivarian Republic of)Vietnam*
21.6
Yemen
55.3
Zambia*63.4
Zimbabwe
56.4
GLOBAL AND REGIONAL AVERAGES+
Sub-Saharan Africa§
78.4
Eastern and
61.4
Southern Africa
West and Central Africa
94.7
Middle East and
24.0
North Africa
South Asia
48.1
East Asia and Pacific
16.3
Latin America
17.5
and Caribbean
CEE/CIS‡
14.4
Developed regions
…
World
40.8

4.9
50.2
27.5
8.1
11.0
10.1
9.5
11.5
10.0
28.9
…
…
…

x

x

x

a

x

15.7
20.1
17.2
9.8
5.4
15.6
9.3
…
17.6
16.6
4.9
5.1
0.6

34.4

33.6

2.1
10.7
19.6
28.5

x
x

…
6.9
6.3
16.1

13.4

x

z

x
x
z
x,z
x,z

x,z

z

13.3
28.9
21.0
24.9

33.9

29.4

28.8
…
7.9
…
15.2

14.8

24.6
46.5
40.0
26.8

…
27.9
…
2.3
2.1
5.9
0.3
…
16.3
2.4
…
…

z
z

x,y
x,y
x,y

a,y
y
y

y
y

y
x,y
y

…

…

16.4
22.7
40.6
…

10.3
16.7
16.9
19.6

x,y
x,y

29.4

a,b
a,b
x
a

b,x
a

a

23.0

58.1
72.1
45.7
67.2
5.7
2.8
38.9
37.8
44.6

CHILD IS A VICTIM
OF EXTREME VIOLENCE

2.2
7.5
0.0
0.0
0.0
0.0
68.2
0.0
0.0

c

c

c

1.7
3.4
4.4
4.0
0.6
0.3
1.0
0.3
0.9

END OFCHILDHOOD
INDEX 2018

Score
Rank
(out of 1,000) (out of 175)

z

864
667
856
766
985
975
656
812
863

84
140
87
114
3
17
142
97
85

34.4

28.3

25.8

20.0

112.8

1.7

3.3

638

–

33.5

31.6

31.9

26.7

129.8

1.9

5.2

562

–

15.3

16.0

6.9

35.8
9.3

22.8
9.7

12.4
10.0

11.0

9.9

10.5

6.2
…
22.9

6.1
…
17.8

5.4
…
12.6

Shading reflects prevalence: Moderate High Very high…	Data are unavailable or outdated (i.e., pre-2005)
a Estimate from recent MICS or DHS (pending reanalysis)b Estimate does not include consensual unionsc 	There is evidence of recruitment and use of children (e.g., as child soliders)d Includes displaced populations from Serbia and Kosovoe Includes displaced populations of Tibetan originx	Data refer to the most recent year available during the period 2005-2011y 	Data differ from the standard definition (interpret with caution)z 	Data are from the secondary source (interpret with caution)

12.8
y,z
y,z**
y,z
y,z**

41.0

5.1

2.5

831

–

44.3
21.2

0.3
0.1

1.7
1.1

719
897

–
–

10.9

74.3

1.3

12.6

801

–

7.3
…
16.0

29.0
…
50.4

0.9
0.2
0.9

0.9
1.1
3.0

913
–
779

–
–
–

29.0
5.7

z

z

§	Includes Eastern and Southern Africa, West and Central Africa, Djibouti, Sudan‡ 	Central and Eastern Europe and the Commonwealth of Independent States+ 	Data refer to the most recent year available during the reference period*	To include as many countries as possible in the rankings, school attendance data
for these 23 countries were sourced from surveys because recent enrollment data
were not available** Excludes China
NOTE: For indicator definitions, primary and secondary data sources, prevalence thresholds andregional classifications, see Methodology and Research Notes.

END OF CHILDHOOD REPORT35

Methodology and Research Notes
Every child has a right to childhood. The concept of childhood is defined in
the Convention on the Rights of the Child.145 It represents a shared vision ofchildhood: healthy children in school and at play, growing strong and confident
with the love and encouragement of their family and an extended community ofcaring adults, gradually taking on the responsibilities of adulthood, free from fear,
safe from violence, protected from abuse and exploitation. This ideal contrasts
starkly with the childhood many children experience.
Countries differ greatly in their ability to protect childhood.
The End of Childhood Index explores this variation acrosscountries, revealing where and how children are being
robbed of the childhoods they deserve. The hope is it will
stimulate discussion and action to ensure that every lastchild fully experiences childhood.

CHILDHOOD ENDERSThis index does not capture the full extent of deprivationsor hardships affecting children. Instead, it focuses on somekey rights or “guarantees” of childhood: life, healthy growthand development, education and protection from harm. If achild experiences all of these, his/her childhood is considered
to be “intact.”
The index tracks a series of events that, should any oneof them occur, mark the end of an intact childhood. These
events are called “childhood enders” and include: child dies,
malnutrition permanently impairs child’s development, childleaves or fails to enter school, child begins work life, childmarries, child has a child, and child is a victim of extreme
violence.
Ender events erode childhood. Depending on the number
and severity of enders experienced, the loss of childhood
could be complete or only partial.146 But once a childexperiences an ender, childhood becomes fractured rather
than complete.147 Each event represents an assault onchildhood. At some point, as the assaults mount up,
childhood ends.
Countries are scored and ranked according to performanceacross this set of enders, revealing where childhood is mostand least threatened.

36

SAVE THE CHILDREN

INDICATORS, DEFINITIONS AND DATA SOURCES
The following eight indicators were selected because they
best represent these enders, are available for a large
number of countries and are regularly updated.148 Data
were obtained from reliable and reputable sources, almost
exclusively UN agencies, and are publicly available tothose interested in doing additional analyses.

ENDER

INDICATOR

Child dies

Under-5 mortality rate

Child is severely
malnourishedChild stunting (%)

Child is outof school

Out-of-school children,
adolescents and youth (%)

Child begins
work life

Child labor (%)

Child marries		

Adolescents currently
married or in union (%)

Child has a child

Adolescent birth rate

Child is a victim
of extreme violence

Population forcibly
displaced by conflict (%)

Child is a victim
of extreme violenceChild homicide rate

Under-5 mortality rate (U5MR): The probability ofdying between birth and exactly 5 years of age, expressed per
1,000 live births. Estimates are for 2016. Source: UN Inter-agency
Group for Child Mortality Estimation (childmortality.org).
Child stunting (moderate and severe): Percentage
of children aged 0-59 months who are below minus twostandard deviations from median height-for-age of the WHO
Child Growth Standards. Estimates are for the most recent
year available 2005-2017. Sources: UNICEF, WHO, World Bank
Group. Joint Malnutrition Country Dataset, December 2017 Edition(data.unicef.org/topic/nutrition/malnutrition/), updated with datafrom recent MICS and DHS surveys for five countries (see Complete
End of Childhood Index).
Out-of-school rate (OOSC) for children, adolescentsand youth of primary and secondary school age: The
number of children, adolescents and youth of official primaryand secondary school age who are not enrolled149 in primary,secondary or higher levels of education, expressed as apercentage of the population of official school age. Children
and young people (about ages 6 and over) who are enrolled
in pre-primary education are considered to be out ofschool.150 Data are for the most recent year available 20052017. Sources: UNESCO’s UIS.Stat (data.uis.unesco.org), supplemented with household survey data from UNESCO’s World
Inequality Database on Education (education-inequalities.org)
for 23 countries (see Complete End of Childhood Index). Note:
Household survey data were used to estimate OOSC rates
only where official data were unavailable or outdated (i.e.,
pre 2005). Rates were derived by dividing the number ofchildren, adolescents and youth out of school (calculated as:
primary OOSC*primary population + lower secondary
OOSC*lower secondary population + upper secondary OOS*upper secondary population) by the total population of
official primary and secondary school age. Official school
age population data were sourced from UIS.Stat and refer tothe same OOSC reference year.
Child labor: Percentage of children 5-17 years old involvedin child labor.151 Data are for the most recent year available
2005-2017. Sources: UNICEF (data.unicef.org/topic/child-protection/
child-labour/), updated with data from recent MICS surveys for fivecountries (see Complete End of Childhood Index).
Adolescents currently married or in union: Percentage
of girls 15 to 19 years of age who have been married andare not either divorced, widowed or separated. Data
including consensual unions or other types of customary
unions are prioritized. Where unions have not been reported
together with currently married, this omission is marked witha “b” in the Complete End of Childhood Index table. Data arefor 2005-2017. Where more than one data point was available for the same reference year, the lowest value was used.
Sources: United Nations, Department of Economic and Social Affairs(UNDESA), Population Division. World Marriage Data 2015,
updated with data from recent MICS and DHS surveys for 58
countries (see Complete End of Childhood Index).

Adolescent birth rate: Births to women aged 15 to 19
per 1,000 women in that age group. Estimates are for 2015
for all but Marshall Islands, which is from 2011. Sources: World
Development Indicators, World Bank (data.worldbank.org/indicator/
SP.ADO.TFRT), supplemented with data for Marshall Islands fromthe SDG Indicators Global Database (unstats.un.org/sdgs/indicators/
database/?indicator=3.7.2).
Population forcibly displaced by conflict or persecution: Total population of concern to UNHCR,152 by country or
territory of origin, expressed as a percentage of the country’s
or territory’s population. Data are for mid-2017. Sources:
UNHCR. Mid-Year Trends 2017. (Geneva: 2018) and UNDESA,
Population Division. World Population Prospects: The 2017 Revision.
Evidence of child soldiers: Countries identified as having
governmental armed forces, government-supported armed
groups or other parties that recruit or use child soldiers.The
term “child soldier” includes children who are serving in any
capacity, including in a support role, such as a cook, porter,
messenger, medic, guard or sex slave. Sources: Child Soldiers
Prevention Act List from Trafficking in Persons Report 2017 (state.gov/
j/tip/rls/tiprpt/ 2017/271111.htm ) and Children and Armed Conflict:
Report of the Secretary-General, Annex I and Annex II (undocs.
org/A/72/361). Note:This indicator is not factored into the index score
but has been noted in the Complete End of Childhood Index table.
Child homicide rate: Estimated number of deaths caused
by interpersonal violence among children and adolescents
aged 0 to 19 years (from WHO or IHME), expressed per
100,000 population in that age group (from UNDESA,
Population Division). Estimates are for 2015. Sources: WHO.
Global Health Estimates 2015: Deaths by Cause, Age, Sex, byCountry and by Region, 2000-2015 (terrance.who.int/mediacentre/
data/ghe/) and UNDESA, Population Division. World Population
Prospects: The 2017 Revision (esa.un.org/unpd/wpp/Download/
Standard/Population/), supplemented with data for State of Palestinefrom Institute for Health Metrics and Evaluation (IHME). Global
Burden of Disease Study 2016 (ghdx.healthdata.org/
gbd-results-tool).

CALCULATIONS
As indicators are measured on different scales, each
was first normalized using a linear scaling technique:
XN = (X – Worst)/(Best – Worst)
Where:
XN is the normalized value
X is the actual value
Worst is the highest observed value for the indicator
Best is the lowest possible value for the indicator
This technique ensures scores range between 0 and 1
and that all indicators are coded positively (i.e., higherscores indicate better performance).153
END OF CHILDHOOD REPORT

37##

ENDER

INDICATOR

BEST

WORST

WEIGHT

Child dies

Under-5 mortality rate

0.0

156.9

1/8

Child is severely malnourishedChild stunting (%)

0.0

57.5

1/8

Child is out of school

Out-of-school children, adolescents and youth (%) 0.0

67.5

1/8

Child begins work life

Child labor (%)

0.0

55.8

1/8

Child marries

Adolescents currently married or in union (%)

0.0

59.8

1/8

Child has a child

Adolescent birth rate

0.0

201.2

1/8

Child is a victim of extreme violence

Population forcibly displaced by conflict (%)

0.0

65.4

1/8

Child is a victim of extreme violenceChild homicide rate

0.0

32.8

1/8

MISSING VALUESThe Complete End of Childhood Index table includes all
185 countries and areas with recent data (from 2005
and onwards) for at least five of the eight indicators,
but not all of them are included in the index rankings.
Countries missing homicide data were dropped from therankings.154 Countries missing up to any two of the otherseven indicators were allowed to remain in the index. This
was the only way to ensure a sufficient number of high-income OECD countries were included, as most do notcollect or publish data on stunting or child labor.
In total, 175 countries had sufficient data to be ranked.
97 countries have data for all eight indicators. 30 countries
are missing one indicator. 48 countries are missing two
indicators, 36 of which are high-income countries.155
For countries lacking stunting, out-of-school or child labor
data, the normalized score for their under-5 mortality rate
was used in place of the missing value(s). Under-5 mortality
is the leading indicator of child well-being and is strongly
correlated with these three indicators.156 For countries lacking
child marriage data, the normalized score for their adolescentbirth rate was ascribed. These two indicators are also highly
correlated.157

38

SAVE THE CHILDREN

Ascribing fillers for these missing values helped ensure
countries were not being rewarded for the lack of data andthat data imputations for missing values were based on acountry’s performance on another, strongly correlated,childhood ender.

PREVALENCE THRESHOLDSAND PERFORMANCE BANDSCountry-level performance on each indicator was assessed
according to the thresholds in the table on the next page.
Countries with “moderate,” “high” or “very high” prevalence of enders were color-coded as shown in the table.
To the greatest extent possible, indicator thresholds werebased on international standards. The classification schemes
used for under-5 mortality and stunting are established.158 The
same breakdowns for stunting were used for out-of-school,
child labor and child marriage. The breakdowns for adolescentbirths were adapted from those used by the World Bank andthe WHO.159 Those for displacement were based loosely on
categories used by UNHCR for a related indicator.160 The
homicide strata were adapted from UNICEF and UNODC.161
To establish tiers or “performance bands,” the boundary
points between threshold levels were normalized for eachindicator and then indexed. Index scores were rounded to two

BAND

All indicators are weighted equally. The overall index score
was calculated by summing across the normalized scoresfor each indicator and then dividing by eight. Scores were
multiplied by 1,000 and rounded to three digits. Countries
were sorted from high to low by this overall index score(with 1,000 being the best possible score) and then ranked
from 1 to 175.
To help ensure index scores are comparable from year
to year and that countries can track progress over time,
the best (i.e., minimum) and worst (i.e., maximum) values
and the indicator weights have been fixed from the inaugural
year onwards as shown in the table above.

SHARE OF CHILDREN MISSINGOUT ON CHILDHOODINDEXSCORES

1

Relatively few children

≥ 940

2

Some children

760 to 939

3

Many children

600 to 759

4

Most children

380 to 599

5Nearly all children≤ 379

INDICATORVERY LOW

LOW

MODERATE

HIGH

VERY HIGH

Under-5 mortality rate (per 1,000)< 10

10 to < 25

25 to < 50

50 to < 100≥ 100Child stunting (%)<5

5 to < 20

20 to < 30

30 to < 40

≥ 40

Out-of-school children and youth (%)<55 to < 20

20 to < 30

30 to < 40

≥ 40Child labor (%)<5

5 to < 20

20 to < 30

30 to < 40

≥ 40Child marriage (%)<5

5 to < 20

20 to < 30

30 to < 40

≥ 40

Adolescent birth rate (per 1,000)< 15

15 to < 50

50 to < 100

100 to < 150≥ 150

Population displaced by conflict (%)<1

1 to < 2

2 to < 5

5 to < 20≥ 20Child homicide rate (per 100,000)<1

1 to < 5

5 to < 10

10 to < 20

≥ 20

≥ 940

760 - 939

600 - 759

380 - 599

≤ 379

			

PERFORMANCE BAND

decimal places and then multiplied by 1,000 to give the cut-off
points for each tier. Countries were placed into one of five bands
according to their index scores (see table on bottom of page 38).

COUNTRY CLASSIFICATIONThe End of Childhood Index presents data for the world asa whole and for various country groupings. Regions areclassified as “developing” or “developed,” as consistent
with the United Nations system.162 Developing regions
are further broken down into the subregions listed at thebottom of the Complete End of Childhood Index table on page
35. These groupings are based on UNICEF’s nomenclatureand regional classification. For a list of countries andterritories in each region, see: UNICEF, The State of theWorld’s Children 2016, p.112.
Global and regional data were sourced from the UN,163
with the exception of out-of-school, forced displacement
and child homicide rates. Regional averages for these three
indicators were calculated by Save the Children, as wereglobal rates for the last two. Each was calculated as aweighted average, with the relevant population used as theweights.164 All UNICEF program countries with available data
were included in these estimates.165 Population coverage
was at or above 90 percent for all region-indicator pairs.166
The designations employed in this report do not imply
the expression of any opinion whatsoever on the part ofSave the Children concerning the legal status of any country
or territory or concerning the delimitation of its frontiers
or boundaries.

LIMITATIONS AND CAVEATS
It would be impossible to include all of the factors thaterode childhood in a single index. This index focuses only
on the most significant enders for which reliable andcomparable data are widely available. Some indicators(e.g., sexual violence, trafficking, hazardous work) would
have been included had there been sufficient data. Others(e.g., incarceration, orphanhood, migration, bullying,corporal punishment, substance use) had data but weren’t
included because they do not necessarily – in and ofthemselves – signal the end of childhood. A child who
is incarcerated, for example, can receive substantial
rehabilitation services including counseling, schooling and a
reliable network of caring adults. Many potential indicators(e.g., child abuse) were also discarded due to data quality
concerns or because they weren’t the most relevant
indicator for the ender in question (e.g., suicide forchild dies).167
Save the Children has not independently verified the data
used in this report. To ensure the data are of the highest
quality, all data are from reputable international sourcesthat closely review and adjust national data to ensure thatthey are as accurate and comparable as possible.
The index presents the most recent data available as of
15 March 2018. Data are not available for the same reference
year for all indicators or for all countries. Of the 175 countries
ranked, 97 have very recent data (i.e., 2011-onward) for all
indicators; 78 countries have at least one data point from2005-2010.
For 16 countries without official education data, as well
as seven whose most recent official figures predate 2005,
household survey data were used to give an indication of
the extent of exclusion from education.168

TECHNICAL NOTE ON GLOBALESTIMATE CALCULATION
In 2017, Save the Children’s first End of Childhood Report
revealed that at least 700 million children worldwide had
been robbed of their childhoods. This year’s report looks
at the number of children at risk of a prematurely ended
childhood. The number of children at risk of missing out on
END OF CHILDHOOD REPORT

39

childhood are defined as those living in countries characterized by one or more of three grave threats to childhood:
conflict, poverty and discrimination against girls.
Countries characterized by conflict or fragility referto the 36 countries and areas included on the World Bank
Group’s Harmonized List of Fragile Situations FY18: Afghanistan,
Burundi, Central African Republic, Chad, Comoros, Congo,
Côte d’Ivoire, Democratic Republic of the Congo, Djibouti,
Eritrea, Gambia, Guinea-Bissau, Haiti, Iraq, Kiribati, Kosovo,
Lebanon, Liberia, Libya, Mali, Marshall Islands, Federated Statesof Micronesia, Mozambique, Myanmar, Papua New Guinea,
Sierra Leone, Solomon Islands, Somalia, South Sudan, Sudan,
Syria, Togo, Tuvalu, West Bank and Gaza,Yemen and
Zimbabwe.169 For details see www.worldbank.org/en/topic/
fragilityconflictviolence/brief/harmonized-list-of-fragile-situations. This list of countries is imperfect. It does not, for example,
include many populous countries with localized conflicts (e.g.,
Nigeria, Pakistan). As a result, figures resulting from thiscountry set are conservative estimates.
Countries characterized by poverty include (a) low-income countries for FY2018 and (b) countries with over halfof their population living below the international poverty lineof $3.20 a day (2011 PPP). For (b) the latest available data
2005-2017 were used. Data were sourced from the WorldBank (see datahelpdesk.worldbank.org/knowledgebase/articles/906519 and data.worldbank.org/indicator/SI.POV.
LMIC?view=chart). All 47 countries meeting one or both ofthese criteria are noted in the rankings table on page 31.
Countries characterized by discrimination against
girls are those that have gender disparities disfavoring girls
with regards to a) enrollment in primary or secondary
school or b) mortality. For (a) this included countries with agender parity index (GPI) of less than 0.97 for the primaryor secondary net enrollment rate (NER). Where NERs were
missing or outdated (24 countries), net attendance rates(NARs) were used. UNESCO Institute for Statistics was theprimary source (see data.uis.unesco.org). Where UIS did notreport NARs (China, Kiribati, Somalia), UNICEF’s data wereused (see data.unicef.org/topic/education/overview). Data are
the latest available 2005-2017. Six countries lacked education
data altogether (Austria, Czech Republic, Germany, Libya,
Singapore and Slovakia); an additional six countries had
incomplete data (Botswana, China, Papua New Guinea,
Russian Federation, Somalia and Trinidad and Tobago). For(b) this set included countries with a male-to-female infantmortality rate (IMR), child mortality rate (CMR) or under-5
mortality rate (U5MR) sex ratio less than 1.0. For IMR and
U5MR, this included India and Tonga. For CMR it included
Central African Republic, India, Iran, Nepal, Niger andPakistan.170 Estimates were for 2016 and sourced from the
UN Inter-agency Group for Child Mortality Estimation(UNIGME) and downloaded from www.childmortality.org.
All 55 countries meeting one or both of these criteria
are noted in the rankings table on page 31.
An estimated 1.2 billion children live in countries characterized by one or more of these key threats to childhood. To
arrive at this total, all children living in countries in either orboth of the first two categories were summed, along withgirls living in countries exclusively characterized by the third.
In other words, in the 18 countries characterized only bydiscrimination against girls, only the number of girls (i.e., not
all children) were included in the global count. The same
treatment was used for counting children in countries
characterized by at least two threats (i.e., in the 17 countries
characterized by discrimination against girls and either
conflict or poverty (but not both), only girls were includedin the global total).171
Breakdowns by threat are included in the table below.
Children living in countries facing two of these three threats,some 537 million children, are deemed to be at “high risk” ofmissing out on childhood. Children living in countries facing
all three threats, some 153 million children,172 are said to beat “extremely high risk” of missing out on childhood.

COUNTRIES#% of total1# (millions)% of total2Countries characterized by conflict

34

18%

239

10%

Countries characterized by poverty

47

25%

1,008

44%

Countries characterized by discrimination against girls

55

30%

5763

51%3

Countries characterized by at least 1 threat

76

41%

1,211

53%

Countries characterized by at least 2 threats

40

22%

537

23%

Countries characterized by all 3 threats

20

11%

153

7%

		

Out of 185 countries included in the Complete End of Childhood Index 2018.
²Out of the total number of children worldwide (mid-2016).
3
Analysis was limited to girls only (i.e., figures do not include boys).
1

40

CHILDREN

SAVE THE CHILDREN

Endnotes¹ An estimated 1.2 billion children are at risk of missing out on childhood. This
figure includes all boys and girls living in countries characterized by conflict/fragility or widespread poverty as well as girls living in countries characterized
by discrimination against girls (i.e., not also poverty or conflict). The same
rules apply to the 537 million children living in countries characterized by two
or more of these threats, those deemed to be at “high risk” of missing out onchildhood (i.e., boys were counted only in countries facing both poverty andconflict, not in countries facing discrimination against girls and one other threat).
The 153 million children at “extreme risk,” however, include both boys and girls
in countries characterized by all three threats. See Methodology and Research
Notes for details.

19
UNESCO Institute for Statistics. “One in Five Children, Adolescents and Youth is
Out of School.” UIS Fact Sheet No.48. (Montreal: 2018) and UNICEF. Progress forChildren – Learning from the MDGs.

Countries characterized by poverty (47 in total) include low-income countries
and countries with over half of their population living below the international
poverty line of $3.20/day. See Methodology and Research Notes for details. All
47 countries are noted in the rankings table on page 31.

23
In addition to the three “lenses of exclusion” discussed in this report, End ofChildhood Index data can often be disaggregated by other relevant dimensions ofinequality such as geographic location (i.e., urban/rural), age, race/ethnicity, subnational region, religion and disability. In many cases, some of the most deprived
children belong to these other sub-groups. For more on other excluded groups
not covered in this report, see, for example: Save the Children. Every Last Child:The
Children the World Chooses to Forget. (London: 2016)

2

3
Throughout this report, the terms “fragile states,” “fragile contexts,” “fragile
and conflict-affected states” and “conflict-affected countries” are usedinterchangeably. This set of countries refers to those included on the WorldBank Group’s Harmonized List of Fragile Situations FY18. Fragile situations have
either a) a harmonized average Country Policy and Institutional Assessment(CPIA) country rating of 3.2 or less, or b) the presence of a United Nations and/or regional peacekeeping operation or c) presence of a United Nations and/or regional peace-building and political mission. The full list with details can befound at <http://pubdocs.worldbank.org/en/189701503418416651/FY18FCSLISTFinal-July-2017.pdf> Accessed 10 January 2018. Index data are available for 34of these 36 countries/areas (all but Kosovo and Micronesia). Note: A recent study
put the number of children living in conflict zones (not conflict-affected countries)
at 357 million (see endnote 73).

Countries characterized by discrimination against girls (55 in total) are thosethat have significant gender-based gaps in child mortality or enrollment inprimary or secondary school. See Methodology and Research Notes for details.
All 55 countries are noted in the rankings table on page 31.

4

The Convention on the Rights of the Child (CRC) represents a global consensus
on the terms of childhood. It recognizes childhood as a separate space fromadulthood defined by a specific set of rights. This report shows that for hundredsof 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 concept of childhood,see UNICEF’s State of the World’s Children 2005.

5

UNHCR. Figures at a Glance. www.unhcr.org/en-us/figures-at-a-glance.html(accessed 24 March 2018) and UNICEF. Children on the Move: Key Facts and Figures.
(New York: 2018)

6

Save the Children. The War on Children:Time to End Grave Violations Against Children
in Conflict. 2018

7

UNICEF. “25 million child marriages prevented in last decade due to accelerated
progress, according to new UNICEF estimates” <www.unicef.org/media/
media_102735.html> Accessed 6 March 2018.

8

9

UNICEF. Progress for Every Child in the SDG Era. (New York: 2018)

A 2013 study found that over the recent past, Latin America and the Caribbean
was the only region where births to girls under age 15 actually rose. In thisregion, such births are projected to rise slightly through 2030. Source: UNFPA.
Motherhood in Childhood: Facing the Challenge of Adolescent Pregnancy. (New York:
2013)
10

11

UNFPA. Adolescent Pregnancy: A Review of the Evidence. (New York: 2013)

UNICEF. Progress for Every Child in the SDG Era. (New York: 2018) and UNICEF.
Progress for Children: Beyond Averages – Learning from the MDGs. (New York: 2015)
12

13
UNICEF <data.unicef.org/topic/nutrition/malnutrition/#> (accessed 24 March2018) and UNICEF. Progress for Children – Learning from the MDGs.
14
UNICEF <data.unicef.org/topic/nutrition/malnutrition/#> Accessed 24 March2018.

Osgood-Zimmerman, A et al. “Mapping Child Growth Failure in Africa
Between 2000 and 2015.” Nature, vol. 555, pp. 41-47 (1 March 2018) doi:10.1038/
nature25760. See also: UNICEF. Progress for Every Child in the SDG Era. (New York:
2018)
15

16

UNICEF. Progress for Every Child in the SDG Era.

UNICEF. Committing to Child Survival: A Promise Renewed. Progress Report 2015.
(New York: 2015)17

18

UNIGME. Levels & Trends in Child Mortality: Report 2017. (UNICEF: 2017)20
UNESCO. More Than One-Half of Children and Adolescents Are Not LearningWorldwide. UIS Fact Sheet No. 46. (Montreal: 2017)21
Save the Children’s analysis of data from UNESCO Institute for Statistics
database <UIS.Stat>, Accessed 24 March 2018.
22
ILO. Global Estimates of Child Labour: Results and Trends, 2012-2016. (Geneva:
2017)

24
Only 172 of 175 ranked countries had sufficient data for this analysis (i.e., had
two years of index data). The other three countries (Bahrain, Canada and United
Arab Emirates) are new additions this year to the End of Childhood Index.
25
Countries characterized by poverty (47 in total) include low-income countries
and countries with over half of their population living below the international
poverty line of $3.20/day. See Methodology and Research Notes for details. All
47 countries are noted in the rankings table on page 31.
26
Children living in extreme poverty are defined as anyone under the age of 18
living in households living on $1.90 a day or less per person. Estimates are for2013. Source: UNICEF and World Bank. Ending Extreme Poverty: A Focus on Children.
(New York and Washington, DC: 2016). See also Newhouse et al. Policy ResearchWorking Paper 7845: New Estimates of Extreme Poverty for Children. (World Bank:
Washington, DC: 2016).
27
Save the Children. Child Poverty:What Drives it and What it Means to Children
Across the World. (London: 2016)28
Data are for 2016. Source: National Center for Children in Poverty. Basic Facts
about Low-Income Children: Children under 18 years, 2016. (New York: 2018)
29

UNICEF and World Bank. Ending Extreme Poverty: A Focus on Children.

Data are for 2016. Source: National Center for Children in Poverty. Basic Facts
about Low-Income Children: Children under 18 years, 2016.
30

31
Results from background research done for this report and Save the Children.
Child Poverty:What Drives it and What it Means to Children Across the World.
32
See, for example: Save the Children. Child Poverty:What Drives it and Whatit Means to Children Across the World. World Bank. Fair Progress? Educational
Mobility Around the World. (forthcoming) and Bhalotra and Rawlings (2011).
“Intergenerational Persistence in Health in Developing Countries: The Penalty ofGender Inequality?” Journal of Public Economics, vol. 95, no.3, pp. 286-299.

Lopez Vilaplana, C. Children at Risk of Poverty or Social Exclusion. Statistics in Focus.
(Brussels: EuroStat: 2013)

33

34

UNIGME. Levels & Trends in Child Mortality: Report 2017.

Save the Children’s analysis based on UNIGME 2017 and UNDESA, Population
Division, World Population Prospects:The 2017 Revision (New York: 2017)
35

36
This estimate was calculated by UNIGME and based on data for 99 countries
with estimates of under-5 mortality by wealth quintile. Source: UNIGME. Levels &Trends in Child Mortality: Report 2017.
37
Calculations by Save the Children based on data for 89 countries with
under-5 mortality rate estimates disaggregated by wealth quintile. Source:
Save the Children, Groups-based Inequality Database (GRID) <campaigns.
savethechildren.net/grid>
38
European Union. Roma Health Report: Health Status of the Roma Population. Data
collection in the Member States of the European Union. (Brussels: 2014)39
In 2015, the infant mortality rate for American Indians was 8.2,
compared to 5.9 for the United States as a whole. Source: National
KIDS COUNT Data Center <datacenter.kidscount.org/data/tables/21-infant-mortality-by-race?loc=1&loct=2#detailed/1/any/fal
se/573,869,36,868,867/10,11,9,12,1,13/285,284> Accessed 25 March 2018.
40
Data for First Nations, Métis and Inu/Inuit peoples in Canada are all but absent
in national health information systems. Recent peer-reviewed health studies have,

END OF CHILDHOOD REPORT

41

however, reported much higher infant mortality rates among these groups (Forexamples see: Janet Smylie. “Aboriginal Infant Mortality Rate in Canada.” The
Lancet, vol. 380, issue 9851, 1384). The collection of health data on indigenous
peoples is necessary to address these inequities, but it must be collected throughprocesses that support their right of self-determination.
UNICEF. Committing to Child Survival: A Promise Renewed. Progress Report 2015.
(New York: 2015)
41

Among the 99 countries with under-5 mortality rate estimates by wealthquintile. Source: UNIGME. Levels & Trends in Child Mortality: Report 2017.
42

UNICEF, WHO and the World Bank Group. Levels and Trends in Child Malnutrition.
UNICEF/ WHO/ World Bank Group Joint Child Malnutrition Estimates: Key Findings ofthe 2017 edition. (New York, Geneva and Washington, DC: 2017)43

UNICEF. The State of the World’s Children 2017. Table 11: Disparities byHousehold Wealth. (New York: 2017)
44

45

UNICEF. Progress for Children: Beyond Averages – Learning from the MDGs.

65
UNFPA. Girlhood, Not Motherhood: Preventing Adolescent Pregnancy. (New York:2015)
66
The Poverty Site. Underage Pregnancy.<poverty.org.uk/24/index.shtml> Accessed
4 February 2018.
67
National Institute of Statistics, Directorate General for Health, and ICF
International. Cambodia Demographic and Health Survey 2014. (Phnom Penh,
Cambodia, and Rockville, Maryland, USA: 2015)
68
Average based on the latest available disaggregated data for 69 countries.
Source: WHO Global Health Observatory Data Repository <apps.who.int/
gho/data/node.main.nHE-1550?lang=en> See also: UNFPA. The State of World
Population 2017:World’s Apart: Reproductive Health and Rights in an Age of Inequality.
(New York: 2017) p.63.

46

Save the Children’s analysis of UNICEF, WHO, World Bank Group Joint
Malnutrition Estimates, May 2017 edition

69
World Bank. Economic Impacts of Child Marriage: Global Synthesis Report.
(Washington, DC: 2017)47
McCoy, DC, et al. (2016) “Early Childhood Developmental Status in Low- andMiddle-Income Countries: National, Regional, and Global Prevalence Estimates
Using Predictive Modeling.” PLoS Med, vol. 13, no. 6: e1002034

70
WHO. Violence Prevention:The Evidence: Promoting Gender Equality to Prevent
Violence Against Women. (Geneva: 2009)

See, for example, Filmer, Deon, “Disability, Poverty, and Schooling in Developing
Countries: Results from 14 Household Surveys,” World Bank Economic Review,
vol. 22, no. 1, 2008, pp. 141–163; World Bank. People with Disabilities in India: FromCommitments to Outcomes. (Washington, DC: 2009); Loeb, M. E., and Arne H.
Eide, eds., “Living Conditions Among People with Activity Limitations in Malawi:
A National Representative Study,” SINTEF Health Research, Oslo, 26 August
2004; Government of the United Republic of Tanzania, “2008 Tanzania Disability
Survey,” United Republic of Tanzania National Bureau of Statistics (Dar es
Salaam: 2009).
48

UNICEF Innocenti Research Centre. Promoting the Rights of Children with
Disabilities. (Florence: 2007)

49

Save the Children’s analysis of data from UNESCO Institute for Statistics
database <UIS.Stat> Accessed 24 March 2018.

50

Save the Children’s analysis of data from UNESCO Institute for Statistics
database <UIS.Stat> Accessed 24 March 2018.

51

UNICEF. Progress for Children: Beyond Averages – Learning from the MDGs. (NewYork: 2015)

52

71
Darroch, J, et al. Adding It Up: Costs and Benefits of Meeting the Contraceptive
Needs of Adolescents. (New York: Guttmacher Institute: 2016)72
Save the Children. The War on Children:Time to End Grave Violations Against
Children in Conflict.
73
Roughly 240 million children live in the World Bank’s set of 36 fragile andconflict-affected states. See footnote 1. This figure likely underestimates the true
number of children affected by conflict. A recent study of children living within
50 km of all conflict incidents in 2016, for example, estimated that 357 million
children are living in conflict zones. See: Save the Children. The War on Children:
Time to End Grave Violations Against Children in Conflict.
74
Save the Children. The War on Children:Time to End Grave Violations Against
Children in Conflict.
75
In 2016, fragile contexts accounted for more than 1 in 5 (22%) child deaths
globally, even though they are home to only 1 in 9 (11%) children under age
5. In 1990 these states accounted for 12% of under-5 deaths. Source: Save theChildren’s analysis of UN IGME (2017) data.
76

Save the Children. State of the World’s Mothers 2013: Surviving the First Day.

53

Save the Children’s analysis of data from UNICEF’s global database <data.
unicef.org/topic/education/primary-education/#> Accessed 29 January 2018.

Save the Children’s Analysis of UNIGME (2017) data and <https://data.unicef.
org/topic/child-survival/child-survival-sdgs/#>

UNICEF. Progress for Children: Beyond Averages – Learning from the MDGs. (NewYork: 2015)

78

54

World Bank. Poverty and Shared Prosperity 2016:Taking on Inequality.
(Washington, DC: 2016)

55

These countries secure the top three spots for greatest absolute difference inaverage PISA scores between the best-off and worst-off quartiles (as measured
by the PISA index of economic, social and cultural status) for reading, math aswell as science at age 15. Source: OECD Child Well-Being Data Portal <www.
oecd.org/social/family/child-well-being/data/education/> Accessed 4 February
2018.

56

UNESCO UIS and EFA Global Education Monitoring Report. Reducing Global
Poverty Through Universal Primary and Secondary Education. Policy Paper 32/Fact
Sheet 44. June 2017.

57

ILO International Programme on the Elimination of Child Labour (IPEC).
Marking Progress Against Child Labour – Global Estimates and Trends 2000-2012.
(Geneva: 2013)

58

UNICEF <data.unicef.org/topic/child-protection/child-labour/#> Accessed 24
January 2018.

59

ILO. Global Estimates of Child Labour: Results and Trends, 2012-2016. (Geneva:
2017)

60

Only 11 countries with recent DHS have disaggregated data. Among these, thepoorest children are, on average, 3 times as likely to be engaged in child labor.
45+ countries have data on children engaged in economic activity; the poorest
children are, on average, 3.7 times as likely to be engaged in economic activity.

61

62

ILO. Global Estimates of Child Labour: Results and Trends, 2012-2016.

The International Center for Research on Women (ICRW) and the World
Bank. Economic Impacts of Child Marriage: Global Synthesis Report. (Washington, DC:2017) and ICRW and the World Bank. Economic Impacts of Child Marriage: Global
Synthesis Brief. (Washington, DC: 2017)

63

42

64
The worldwide rate is 50 births per 1,000 girls aged 15-19. Sub-SaharanAfrica’s rate is 122 births per 1,000 girls, and in Latin America and the Caribbean,
the rate is 74 births per 1,000 girls. See the Complete End of Childhood Index on
pages 32-35.

SAVE THE CHILDREN

77

UNIGME. Levels & Trends in Child Mortality: Report 2017.

FAO, IFAD, UNICEF, WFP and WHO. The State of Food Security and Nutrition in
the World 2017. Building Resilience for Peace and Food Security. (Rome: FAO: 2017)
79

80
International Food Policy Research Institute. 2014–2015 Global Food Policy
Report. (Washington, DC: 2015)
81
FAO, IFAD, UNICEF, WFP and WHO. The State of Food Security and Nutrition in
the World 2017. Building Resilience for Peace and Food Security.
82
Pinstrup-Andersen, P, and S. Shimokawa. “Do Poverty and Poor Health andNutrition Increase the Risk of Armed Conflict Onset?” Food Policy, 2008. vol. 33,
no. 6. pp.513-520.
83
Development Initiatives. Global Nutrition Report 2017: Nourishing the SDGs.
(Bristol, UK: 2017)84
UNICEF. Education Uprooted. (New York: 2017) and Justino, Patricia. “Barriers
to Education in Conflict-Affected Countries and Policy Opportunities.” Paper
commissioned for Fixing the Broken Promise of Education for All: Findings from the
Global Initiative on Out-of-School Children (UIS/UNICEF: 2015).
85
REACH, Humanitarian Situation Overview in Syria (HSOS): Governorate
Factsheets, <https://reliefweb.int/sites/reliefweb.int/files/resources/reach_syr_factsheet_hsos_governorate_factsheet_may2017_3.pdf>
86Whole of Syria Protection Sector. 2018 Protection Needs Overview V2. (2017)

87

UNICEF. Progress for Children: Beyond Averages – Learning from the MDGs.

UNESCO. EFA Global Monitoring Report – Education for All 2000-2015:
Achievements and Challenges. (Paris: 2015)

88

The Global Initiative on Out-of-School Children <allinschool.org/location/>
Accessed 28 January 2018.

89

90
That is, they have a net enrollment rate (NER) or net attendance rate (NAR)
of more than 95 percent. Net enrollment data are prioritized. Net attendance
data from surveys were used when primary net enrollment data were notavailable. Sources: UNESCO Institute for Statistics <data.uis.unesco.org>, 2018,
based on administrative NER data for the most recent year available during
the period 2010-2016 and UNICEF <data.unicef.org/topic/education/primaryeducation/>, 2018, based on NAR data from MICS, DHS and other nationally
representative surveys for the most recent year available 2006-2016. Accessed
22 April 2018.

UNICEF. Education Uprooted: For Every Migrant, Refugee and Displaced Child,
Education. (New York: 2017)
91

92
Justino, Patricia. “Barriers to Education in Conflict-Affected Countries andPolicy Opportunities.”
93
UNICEF. Education Uprooted: For Every Migrant, Refugee and Displaced Child,
Education.
94

UNHCR. Missing Out: Refugee Education in Crisis. (Geneva: 2017)

For this analysis, the ILO sourced its countries “affected by armed conflict”
from the Report of the Secretary-General on children and armed conflict,submitted to the UN Security Council in 2015. The category “countries af­fectedby armed conflict” includes Afghanistan, Central African Republic, Colombia, Iraq,
Mali, Nigeria, Philippines, South Sudan, Ukraine and Yemen. Countries affected byarmed conflict for which child labor data are not available in the current global
estimates include: Libya, Myanmar, Somalia, Sudan and Syria. Source: ILO. Global
Estimates of Child Labour: Results and Trends, 2012-2016. (Geneva: 2017)
95

96

UNHCR. Missing Out: Refugee Education in Crisis. (Geneva: 2017)

97
Justino, Patricia. “Barriers to Education in Conflict-Affected Countries andPolicy Opportunities.”

UNICEF. Preparing for the Future of Children and Youth in Syria and the Region
through Education: London One Year On: Brussels Conference Education Report. (April2017) p.5.
98

99

University of Jordan. National Child Labour Survey 2016 of Jordan. (Amman: 2016)

100

UNICEF. Falling Through the Cracks:The Children of Yemen. (2017)

Save the Children. Too Young to Wed:The Growing Problem of Child Marriage Among
Syrian Girls in Jordan. (2014)
101

102

Girls Not Brides. Child Marriage in Humanitarian Settings. (2017)

103
UNICEF. Preparing for the Future of Children and Youth in Syria and the Region
through Education: London One Year On, Brussels Conference Education Report, April
2017, p. 5.
104

Whole of Syria Protection Sector. 2018 Protection Needs Overview V2. (2017)

105

UNICEF. A Study on Early Marriage in Jordan 2014. (Amman: 2014)

106
Government of Lebanon and the United Nations. Lebanon Crisis Response Plan
2017-2020. (2017)

Girls Not Brides. “Child Marriage and the Syrian Conflict: 7 Things You Needto Know.” <www.girlsnotbrides.org/child-marriage-and-the-syrian-conflict7-things-you-need-to-know/> Posted Tuesday June 20, 2017 and CARE UK.
To Protect Her Honour: Child Marriage in Emergencies, the Fatal Confusion Between
Protecting Girls and Sexual Violence. (London: 2015)
107

108

UNICEF. Falling Through the Cracks:The Children of Yemen. (2017)109
Latiff, Rozanna and Ebrahim Harris. “Sold Into Marriage – How Rohingya
Girls Become Child Brides in Malaysia.” Reuters. 15 February 2017.

Guilbert, Kieran. “Child Marriage Threatens Future of Young Central African
Republic Refugees in Cameroon.” Reuters. 8 November 2016.
110

Save the Children. Every Last Child. (London: 2016) and Every Last Girl (London:
2016)
111

Countries characterized by discrimination against girls (55 in total) arethose that have significant gender-based gaps in child mortality or enrollment inprimary or secondary school. See Methodology and Research Notes for details.
All 55 countries are noted in the rankings table on page 31.
112

113
WHO, Adolescent Pregnancy Factsheet <www.who.int/mediacentre/factsheets/
fs364/en/> Accessed 27 January 2018 and UNICEF. “25 million child marriages
prevented in last decade due to accelerated progress, according to new UNICEF
estimates” <www.unicef.org/media/media_102735.html> 6 March 2018.
114

See rankings table on page 31.

In 2016, there were 131.2 million boys and 131.6 million girls out of school.
In 2015, there were actually more boys than girls out of school (132.5 vs. 131.9
115

million). Source: Save the Children’s analysis of data from UNESCO Institute for
Statistics database <UIS.Stat>, Accessed 24 March 2018.
116
Stromquist, Nelly P. “Out-of-School Children: Why Gender Matters?” Paper
commissioned for Fixing the Broken Promise of Education for All: Findings from the
Global Initiative on Out-of-School Children (UIS/UNICEF:2015).

World Bank. World Development Report 2012: Gender Equality and Development(Washington, DC: 2012)

117

118
Primary out-of-school rates are 21 percent and 7 percent, respectively.
Source: UNESCO World Inequality Database on Education <www.educationinequalities.org/> Accessed 25 March 2018.
119
UNESCO Institute for Statistics and Global Education Monitoring Report.
Leaving No One Behind: How Far on the Way to Universal Primary and Secondary
Education? Policy Paper 27/ Fact Sheet 37. (Montreal and Paris: 2016)
120

Save the Children’s analysis of UNESCO Institute for Statistics data, 2018

Nicolai, Susan, et al. Education Cannot Wait: Proposing a Fund for Education in
Emergencies. (ODI: London: 2016)
121

122

UNESCO. Education for All Global Monitoring Report, 2013/14.

Average is unweighted. Source: UNESCO Institute for Statistics global
database, 2018 < data.uis.unesco.org/>
123

124
Save the Children. Every Last Girl: Free to Live, Free to Learn, Free from Harm.
(London: 2016)125

UNFPA. Marrying Too Young: End Child Marriage. (New York: 2012)

126

Ibid.

UNICEF. “25 million child marriages prevented in last decade due toaccelerated progress, according to new UNICEF estimates” <www.unicef.org/
media/media_102735.html> 6 March 2018.
127

128

Ibid.

UNICEF. Achieving a Future Without Child Marriage: Focus on West and Central
Africa. (New York: 2017)
129

130
WHO. Adolescent Pregnancy Factsheet <www.who.int/mediacentre/factsheets/
fs364/en/> Accessed 27 January 2018.
131
Wodon, Q, et al. Ending Child Marriage: Legal Age for Marriage, Illegal Child
Marriages, and the Need for Interventions. (London and Washington, DC: Save theChildren and World Bank: 2017)132
Tahirih Justice Center. Falling Through the Cracks: How Laws Allow Child Marriage
to Happen in Today’s America. (2017)133
WHO, London School of Hygiene and Tropical Medicine and South African
Medical Research Council. Global and Regional Estimates of Violence Against Women:
Prevalence and Health Effects of Intimate Partner Violence and Non-Partner Sexual
Violence. (2013)
134
CARE UK. To Protect Her Honour: Child Marriage in Emergencies, the Fatal
Confusion Between Protecting Girls and Sexual Violence. (London: 2015), World Vision
UK. Untying the Knot: Exploring Early Marriage in Fragile States. (Milton Keynes:2013) and Save the Children. The War on Children:Time to End Grave Violations
Against Children in Conflict.
135
United Nations Office on Drugs and Crime. Global Report on Trafficking 2016.
(Vienna: 2016)
136

Ibid.

UNICEF. A Statistical Snapshot of Violence Against Adolescent Girls. (New York:
2014)
137

138
Save the Children. The War on Children:Time to End Grave Violations Against
Children in Conflict.
139
UNICEF. A Familiar Face:Violence in the Lives of Children and Adolescents. (NewYork: 2017)
140
Note: Respondents were asked how often before the age of 15 an adult
who was 18 years or older did any of the following to them when they did notwant them to: exposed their genitals to you; made you pose naked in front ofany person or in photos, video or an Internet webcam; touched your genitals
or breasts against your will; or forced you to have sexual intercourse. Source:
UNICEF. A Familiar Face:Violence in the Lives of Children and Adolescents. (New York:
2017)
141
World We Want. Addressing Inequalities: Synthesis Report of Global Public
Consultation. Global Thematic Consultation on the Post-2015 Development
Agenda. (New York: UNICEF and UN Women: 2013)

END OF CHILDHOOD REPORT

43

142
Jones Lisa, et al., “Prevalence and Risk of Violence Against Children with
Disabilities: A Systematic Review and Meta-Analysis of Observational Studies,”
The Lancet, vol.380, no. 9845 (July 2012)of Childhood Index scores for 2017 vs. 2018 (pages 3-5), the dozen “developed”
countries in Central and Eastern Europe were included only in the CEE/CIS
regional analysis.

143
Sexual and Reproductive Health and Rights of Girls and Young Women with
Disabilities: Note by the Secretary-General. 14 July 2017 <undocs.org/A/72/133>

163
Under-5 mortality rate data were pulled from <data.unicef.org>. All otherworld and developing subregional averages were pulled from The State of theWorld’s Children (SOWC) 2017, with the exception of the global average for childlabor, the CEE/CIS average for child labor, and child labor and child marriage
rates for South Asia, which were all pulled from SOWC 2015, as well as the childlabor rate for East Asia and Pacific, which was pulled from SOWC 2016.

144

UNICEF. The State of the World’s Children 2005: Childhood under Threat.

Childhood means more than just the time between birth and adulthood. It
refers to the state and condition of a child’s life – to the quality of those years. As
the most widely endorsed human rights treaty in history, the Convention on the
Rights of the Child, adopted by the UN General Assembly in 1989 and ratified
by all but one country, represents a global consensus on the terms of childhood.
Although there is not absolute agreement on the interpretation of each andevery provision of the Convention, there is substantial common ground on what
the standards of childhood should be. Source: UNICEF. The State of the World’sChildren 2005.
145

146
In some cases, enders unequivocally signal the end of childhood (e.g., death).
Others (e.g., departure from school; child labor) may only chip away atchildhood, especially if remedial action is taken (e.g., child re-enrolls in school;
child stops working).
147
This does not mean that children who experience enders are not still children
or that they cannot still enjoy some aspects of childhood. A child who is out ofschool, for example, may still learn other skills at home. Refugee children stillplay and may study if the right policies and programs are in place. And eventhough they’ve taken on adult roles and responsibilities, child brides and teen
mothers are still children entitled to protection and support.
148
Other selection criteria included: reliability, face validity, comparability, policy
relevance, news-worthiness, contemporaneity and alignment with SDG targets.
149
For the 23 countries where household survey data are used, the indicator
represents the share of school-age children not attending school.
150
The current international standard is to treat children of primary age orolder enrolled in pre-primary education as out of school because pre-primaryeducation does not meet the same education standards as formal primary or
higher education. This may result in an overestimate of the rate of children who
are not in school, in particular in countries where pre-primary education iscompulsory.
151
A child is considered to be involved in child labor under the following
conditions: (a) children 5-11 years old who, during the reference week, did atleast one hour of economic work or at least 28 hours of household chores, (b)children 12-14 years old who, during the reference week, did at least 14 hoursof economic work or at least 28 hours of household chores, (c) children 15-17
years old who, during the reference week, did at least 43 hours of economic
work or household chores, and (d) children aged 5-17 years old in hazardous
working conditions.
152
Includes refugees, asylum-seekers, internally displaced persons (IDPs),
returnees (refugees and IDPs) and others of concern who do not necessarily
fall directly into any of the other groups but to whom UNHCR may extend its
protection and/or assistance services.
153
Syria’s score for displacement is the only exception. Because this year’s
estimate (68.2 percent) exceeds the “worst” possible score of 65.4, Syria’s
normalized score is actually negative (-0.04).

In other words, Marshall Islands and Tuvalu would not have been indexed even
if they had sufficient data.
154

The Complete End of Childhood Index table indicates the indicator(s) that are
missing for the 78 countries missing one or two indicators.

155

156
In the inaugural year, correlation coefficients were 0.68, 0.76 and 0.74,
respectively.
157

The correlation coefficient was 0.81.

See, for example, <data.unicef.org/topic/child-survival/under-five-mortality/and data.unicef.org/topic/nutrition/malnutrition/>158

159
See <gamapserver.who.int/mapLibrary/Files/ Maps/Global_
AdolescentBirthRate_2015.png and data.worldbank.org/indicator/SP.ADO.
TFRT?view=map>
160

UNHCR. Mid-Year Trends 2016. (Geneva: 2017), p.11

See UNICEF. Hidden in Plain Sight: A Statistical Analysis of Violence Against Children.
(New York: 2014), p.39 and UNODC. Global Study on Homicide 2013. (Vienna: 2014),
p.12
161

162
This designation is made for the purpose of statistical analysis only. For
the list of countries belonging to “developed” and “developing” regions, see:<unstats.un.org/unsd/methodology/m49/>. Note that for the comparison of End

44

SAVE THE CHILDREN

164
The official primary + secondary school-aged population in 2016 (UIS.Stat),total national population in 2017 (UNDESA) and child population aged 0-19
in 2015 (UNDESA) were used as weights for out-of-school, displacement andchild homicide averages, respectively. The only exceptions were school-aged
populations for Brazil (2015), Iraq, Libya, Moldova (2015), Ukraine (2014), San
Marino, South Korea, Sudan,Vanuatu, which were from 2017 unless otherwise
noted. The global average for child homicide was estimated in the same way(i.e., as a weighted average of country rates) but the rate of forced displacement
worldwide was calculated directly from the latest global count from UNHCR(unhcr.org/en-us/figures-at-a-glance.html) and world population data fromUNDESA, both for the start of 2017.
165
Even if a country didn’t have sufficient data to be included in the Complete End
of Childhood Index table, if it had indicator-level data, it was included in global andregional rates for that indicator.
166
Coverage exceeded 99% for all estimates except for school-aged populationsin CEE/CIS (97% coverage) and the Middle East and North Africa (90%coverage).
167
A list of excluded indicators has been compiled and can be provided uponrequest.
168
Household surveys measure participation as attendance at any time during
the preceding school year – a fairly generous approach that is not substantively
dissimilar to formal enrollment. Holding constant other reasons that survey andadministrative data may differ (such as attendance in non-formal schools), one
would expect attendance to be slightly lower than enrollment since children may
be officially enrolled but not attend. For the seven countries with old enrollment
data, attendance rates are actually higher than enrollment figures, which
produced more favorable results.
169
The World Bank does not distinguish between fragility due to conflict and war
and fragility due to political crisis (which is often accompanied by violence). It
also refers to this set of countries both as “fragile situations” and “fragile andconflict-affected situations.” UNICEF has also referred to these states simply as“conflict-affected countries.” These terms are used interchangeably throughout
the report to refer to this same set of countries.
170
Because of the uncertainty of these estimates, only countries with sex ratios
below 1.0 were identified. With the exception of Central African Republic, Niger
and Tonga, all other countries have been previously identified as having higherthan-expected female mortality (see Alkema et al. “National, Regional, andGlobal Sex Ratios of Infant, Child, and Under-5 mortality and Identification ofCountries with Outlying Ratios: A Systematic Assessment.” Lancet Global Health2014; 2: e521–30). Central African Republic and Niger also have large genderdisparities in education, meaning they would have made this category anyway.
171
There are 40 countries that face at least two threats. Of these, 23 countries
are characterized by poverty and conflict (some are also characterized bydiscrimination against girls) and 17 are characterized by discrimination against
girls and either poverty or conflict (but not both). Summing all children living incountries in the first category and only girls in countries in the second places
537 million children or nearly 1 in 4 children worldwide at high risk of missingout on childhood.
172
This figure includes both boys and girls in these 20 countries. Why count all
children in countries characterized by conflict, poverty and discrimination against
girls instead of only girls in these countries? Counting just girls would miss theinter-generational component. Boys living in conflict-affected countries where
poverty is widespread born to mothers who have been discriminated against
face a triple threat to their childhoods. In this way, discrimination against girls(e.g., which results in lower levels of maternal education) is also a handicap forboys.

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 andfeedback from many colleagues across the global Save theChildren movement. Special thanks for substantive inputs
and support at different stages to: Michel Anglade, Smita
Baruah, Anita Bay, George Graham, Carolyn Miles, Richard
Morgan, Bernice Romero, Sean Ryan and Patrick Watt.
We are grateful to colleagues from across Save theChildren for comments and inputs that have helped improveand enrich the report: Kitty Arie, Yeva Avakyan, Khadija Badri,
Claire Blackburn, Misty Buswell, Paul Butcher, Wendy Christian,
Rob Doble, Habtamu Fekadu, Jorge Freyre, Gunvor Knag
Fylkesnes, Jesse Hartness, Eric Hazard, Joan Jennings, Michael
Klosson, Kristen Lacey, Alexis Le Nestour, Tracy Manners,
Winifride Mwebesa, Sara Neumann, Taskin Rahman, Vishna
Shah, Evan Schuurman, Janine Scolpino, Lene Steffen, Alison
Sutton, Eric Swedberg, Devendra Singh Tak, Andrew Wainer,
Lisa Wise and Simon Wright.
We thank colleagues who produced case studies for thisreport who are based in country offices in Bangladesh,
Democratic Republic of the Congo, Ethiopia, India, Jordan,
Lebanon, Nigeria and Uganda. Special thanks to Angelica
Cadavid, Penny Crump, Natasha Dos Santos, Aisling Finneran,Madhu Kalra, Kate Kenny and Mike Sunderland for theirleadership in identifying and producing case studies, and to
many others across the organization who supported theprocess.
Many thanks to Tanu Anand, Catherine Bowden, Kandace
Doyle, Charlotte Greene and Holly Taylor for global
coordination and project management. Thanks also to Judy
Cusick, Lois Jensen and Mike Kiernan for editorial support.
And to Joe Ansah, Senad Ibrahimbegovic and Maribel Paredes
for support on design and production.
Design by Alison Wilkes. Cover design by Joe Ansah.

Save the Children believes every child deserves a future. Aroundthe world, we give children a healthy start in life, the opportunity
to learn and protection from harm. We do whatever it takes forchildren – every day and in times of crisis – transforming theirlives and the future we share.

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ON THE COVER
Clockwise from upper left:
Bdai from Vietnam (photo by
Jonathan Hyams); Kamal*, Arwin*
and Sejun* from Nepal (photo by
Oli Cohen); Gina* from Democratic
Republic of the Congo (photo by
Joan Marie del Mundo); Fatema*, aRohingya refugee living in Bangladesh(photo by GMB Akash/Panos
Pictures/Save the Children); Olivia
from the United States (photo by
Susan Warner); Lixi from Nicaragua(photo by Dorothy Sang); Farah*,a Syrian refugee living in Lebanon(photo by Louis Leeson); Avina*
from India (photo by CJ Clarke);
Saeed* from Syria (photo by Save
the Children) and Sifa*, a Congolese
refugee in Uganda (photo by
Hannah Maule-ffinch).