In 2000, 189 U.N. member states, including the United States, adopted the U.N. Millennium Declaration. In the Declaration, countries made commitments to achieve a series of measurable development targets worldwide by 2015 known as the "Millennium Development Goals" (MDGs or Goals). In all, there are eight MDGs comprised of 21 quantifiable targets measured by 60 indicators. Table 1 lists the Goals, and Table A-1 in the Appendix provides the corresponding targets. From September 20 to 22, 2010, world leaders gathered at U.N. Headquarters for a High-level Plenary Meeting (the Meeting) to review progress toward achieving the MDGs over the past decade. During the Meeting, participants discussed best practices and challenges to implementing the Goals, and governments adopted a General Assembly resolution outlining a "global action plan" to achieve the MDGs in the next five years. The resolution did not include any financial commitments; rather, it called on governments to fulfill existing aid commitments made at other international meetings and conferences. A key area of discussion among Meeting participants was governments' lack of success in meeting the MDGs in the past 10 years. There is general consensus in the international community that while there has been some progress in achieving the MDGs, the majority of Goals will not be met by 2015. Many also acknowledge that MDG progress is unevenly distributed across countries and regions. Moreover, no progress at all has been made toward some of the Goals, and in a few cases the indicators show regression. The Barack Obama Administration has generally supported the MDGs. President Obama addressed meeting participants on September 22, emphasizing the need for greater sustainability, accountability, and focus on economic growth in development assistance programs. His speech was consistent with the U.S. Strategy for Meeting the MDGs , released by the Administration in July 2010, which highlights four imperatives for achieving the Goals: (1) leveraging innovation, (2) investing in sustainability, (3) tracking development outcomes (not just dollars), and (4) ensuring mutual accountability among aid donors and recipients. In general, the Obama Administration appears to invoke the MDGs as a construct for U.S. development policy more frequently than do members of Congress. Since the Millennium Declaration was adopted in 2000, little legislation has been introduced that, either in whole or in part, addresses the MDGs. Nevertheless, members of the 112 th Congress may be interested in the Goals and the September High-level Meeting from several perspectives: D evelopment assistance in a tight fiscal environment —Members of Congress authorize and appropriate U.S. official development assistance. In light of growing concerns over the federal budget deficit, members may wish to reassess foreign assistance priorities and strategies; New international commitments —Congress may consider commitments made on behalf of the United States in the Meeting's outcome document, Keeping the Promise: United to Achieve the Millennium Development Goals (General Assembly resolution 65/1); and O versight —Members may wish to conduct oversight on the overall effectiveness of the MDGs and the previous and future role of the United States in helping to fulfill the Goals. More broadly, Congress may consider how, if at all, the MDGs should shape existing and future U.S. and international development activities. Selected questions that policymakers may consider follow: In what areas , if any, have the MDGs been successful? Many agree that some MDGs have been met or are on track to be met by 2015. Some are hopeful that the "lessons learned" from these experiences could be transferred to other Goals. Are the MDGs practical? Some experts contend that the Goals provide unrealistic expectations for countries or regions, particularly those starting out at a lower economic threshold than others. Moreover, some argue that the scope and breadth of the MDGs, and a lack of prioritization among them, have affected their progress. What is the role of foreign aid in the MDGs? Some maintain that in order for the MDGs to be fulfilled by 2015, donor countries must fulfill existing aid commitments and make new ones. Others, however, argue that higher aid levels do not necessarily lead to greater development impacts. Who or what is held accountable for MDG progress? Governments are primarily responsible for fulfilling the MDGs. At the same time, it is unclear to whom, if anyone, governments are accountable if they fail to achieve the Goals. This report discusses overarching trends in MDG progress and lessons learned from previous and ongoing efforts to achieve them. It examines U.S. policy toward the MDGs and how, if at all, the Goals fit into U.S. development and foreign assistance policy. It also examines different schools of thought regarding the effectiveness of the Goals, their role in international development, and their long-term sustainability. This report addresses the MDGs as a whole; it does not assess or analyze issues pertaining to the individual Goals. On September 22, the High-level Meeting concluded with the adoption of General Assembly resolution 65/1, a "global action plan" to achieve the MDGs by 2015. In the resolution, entitled Keeping the Promise: United to Achieve the Millennium Development Goals , governments reaffirmed the MDGs and welcomed progress made toward their achievement—recognizing that they can be met with "renewed commitments, effective implementation and intensified collective action by all Member States." At the same time, governments recognized that progress toward the Goals is uneven among regions and between and within countries, and expressed "deep concern" that progress toward the Goals "falls short of what is needed." No new financial commitments were made by governments in the resolution. Instead, governments called for the "expeditious delivery of [aid] commitments already made by developed countries" in the context of the Monterrey Consensus and the Doha Declaration. In the resolution, governments also committed to specific measures related to each of the eight Goals in the next five years, and requested the General Assembly to review progress made toward the Goals, and the implementation of the resolution, on an annual basis. To follow up on these efforts, member states agreed to hold a General Assembly special event on the MDGs in 2013. Countries also requested that the Secretary-General continue to report annually to the General Assembly on progress toward the Goals, and to recommended steps for advancing the U.N. development agenda beyond 2015. During the Meeting, the United Nations, governments, non-governmental organizations (NGOs), and private sector entities also announced individual development commitments. Several organizations and governments, for example, pledged a combined $40 billion over the next five years to accelerate progress on women's and children's health through the Secretary-General's Global Strategy for Women's and Children's Health . Other examples of such commitments follow: South Korea pledged $100 million to support food security and agriculture in developing countries (MDG 1); Dell committed $10 million toward education technology initiatives in 2010 (MDG 2); the World Bank announced it would increase the scope of its results-based health programs by more than $600 million until 2015 (MDG 6); the United States committed $50.82 million for the Global Alliance for Clean Cookstoves, a public-private partnership led by the U.N. Foundation to install clean-burning stoves in kitchens around the world (MDG 7); and the European Union offered €1 billion to the most committed and needy countries to make progress on the Goals they are furthest from achieving (MDG 8). Some of these commitments seem to be specifically created to accelerate progress on the MDGs. Others, however, appear to be part of broader development efforts and initiatives already being undertaken by governments, international organizations, NGOs, and the private sector. In advance of the September 2010 High-level Meeting on the MDGs, governments, NGOs, and others scrutinized MDG indicators to determine progress made toward the Goals. Generally, experts monitoring the MDG indicators have identified two overarching trends. First, while some MDGs are on track to be achieved, others have made no progress at all or, in some cases, have deteriorated. Second, progress toward the Goals is unevenly distributed among regions and countries. The following sections discuss and provide examples of these trends in further detail. While significant progress has been made toward a few MDGs, there is general agreement in the international community that many of the Goals will likely be missed both on a global level and by most countries. No progress at all has been made toward some Goals, and indicators show regression on others. For example, many predict that MDG 1, target 3, halving the number of people who suffer from hunger, will not be achieved. Throughout the 1990s and early 2000s there was some progress in combating hunger worldwide, but any advancements have recently stalled due in part to global food crises and the global economic crisis. In the period from 2005 through 2007, for instance, 830 million people were undernourished, an increase of 13 million from the 1990 level of 817 million. In addition, many observers agree that MDG 2, which aims to ensure that all children complete a full course of primary schooling, will likely remain unfulfilled at the global level. The United Nations and other organizations maintain that there has been progress in this area—for example, enrollment in primary education recently reached 89% in the developing world—but that the pace of this progress is insufficient. For the Goal to be achieved, all children at the official age for primary school in their respective countries would have to have been attending classes by 2009. In over half of Sub-Saharan Africa, however, at least 25% of school-aged children were not enrolled in 2008. Moreover, MDG 4, which addresses child mortality, sets a target of reducing the under-five mortality rate by two-thirds by 2015 that will likely not be met. According to the United Nations, child deaths are falling, but they are not doing so quickly enough to achieve MDG 4. Of the 67 countries with high child mortality rates (described as 40 or more deaths per 1,000 live births), only 10 countries are on track to meet the two-thirds reduction target. Additionally, MDG 5, which seeks to reduce the maternal mortality ratio by 75% by 2015, will likely remain unfulfilled. According to the U.N. Secretary-General, of the health-related MDGs the least progress has been made toward attaining this Goal. In many developing countries, access to safe reproductive health services remains poor, with preventable conditions such as hemorrhage and hypertension accounting for half of all deaths in expectant or new mothers. A wide range of data and research indicates that global progress toward the MDGs is uneven across developing regions and countries. For MDG 1, for example, the percentage of people living in poverty on the global level has decreased; however, most of this decline has been driven by robust economic growth in countries such as China and India. Meanwhile, progress in reducing poverty and hunger in other regions—particularly Sub-Saharan Africa—has stalled or even regressed. For example, the United Nations reports that the world is on track to meet target 1 of MDG 1, halving the proportion of people whose income is less than $1 a day. Many emphasize, however, that progress is driven primarily by the economic success of certain countries. Specifically, strong economic growth in China appears to account for most of the decrease in the number of people living on less than $1.25 a day, while poverty and hunger in other parts of Asia and in Sub-Saharan Africa remain high. Excluding data from China, the United Nations estimates that the absolute number of people living in extreme poverty rose by 36 million between 1990 and 2005. Regional disparities are also apparent in progress toward MDG 3, which seeks to promote gender equality and empower women by eliminating gender disparity in primary and secondary education by 2015. Research indicates that developing regions as a whole are approaching gender parity in educational enrollment. In 2008, for example, there were 96 girls for every 100 boys in primary school and 95 girls for every 100 boys in secondary school. This is an improvement from 1999, when the ratios were 91 to 100 and 88 to 100 in primary and secondary schools, respectively. At the same time, however, gender parity in education remains "out of reach" for many developing countries and regions and in some cases has decreased. In Sub-Saharan Africa, for instance, the percentage of primary school enrollment for girls as compared to boys fell from 82% in 1999 to 79% in 2007. Similarly, in Oceania, progress toward achieving girls' enrollment in primary school has deteriorated or not progressed. Moreover, the United Nations reports that while the world is on track to meet target 3 of MDG 7, halving the proportion of the population without safe drinking water or sanitation, progress is uneven across regions and countries. Four regions have already met the safe drinking water target: Northern Africa, Latin America and the Caribbean, Eastern Asia, and Southeastern Asia. Nevertheless, safe water supply remains a challenge in many developing countries, particularly in rural areas, and across Oceania and Sub-Saharan Africa. (For additional examples of MDG progress by region, see Figure A-1 .) In an effort to determine the most effective ways to achieve the goals in the next five years, participants at the September Meeting discussed common factors or lessons learned that contributed to MDG progress, as well as correlating obstacles that have impeded progress. While many experts assert that there is no "one size fits all" approach to advancing development, and that the most effective policies and interventions will differ by country and by Goal, in the past decade, governments, NGOs, and others have identified certain factors that contribute to the fulfillment of the MDGs. When examining U.S. development policy and efforts to address the MDGs, members of Congress may take these issues into account. They include the need for effective government leadership and ownership of development strategies; effective policies to support implementation , including laws, regulations, standards, and guidelines, general or specific to the MDGs, that impact private behavior, the conduct of service providers and others with whom governments must interact; improved quality, quantity, and focus of investments from both domestic resources and international development assistance based on a holistic approach, including health, education, infrastructure, and business development; appropriate institutional capacity to deliver quality services equally on a national scale, including adequate facilities, competent staff, supplies and equipment, and tools for monitoring; involvement of civil society and communities in achieving the Goals; effective global partnerships involving all relevant stakeholders such as donor and recipient governments, communities, NGOs, and the private sector; and good governance by donors and recipients , including the timely and predictable delivery of aid. At the same time, the existence of these factors in a country or region does not ensure that the MDGs will be achieved. External, and often unpredictable, events can be a significant impediment to MDG progress. For example, many contend that the global financial crisis negatively impacted progress toward the MDGs. There is also broad consensus that armed conflict and violence remain significant threats to any gains made toward the Goals. The United States voted in favor of the U.N. Millennium Declaration in 2000, and some recent U.S. development policy statements allude to the MDGs as a U.S. development policy consideration, if not a guiding framework. In speeches before the United Nations and other international fora over the years, both President George W. Bush and President Barack Obama have emphasized the U.S. commitment to the Millennium Development Goals. However, the two Administrations have used different rhetoric in regard to the MDGs, and many observers believed that this shift anticipated a significant policy change between Administrations. Nevertheless, a review of U.S. development activities and policy statements since the establishment of the MDGs illustrates some of the challenges in drawing conclusions about the role of the MDGs in U.S. foreign assistance policy. While the Millennium Declaration was agreed to during the Clinton Administration, the MDGs themselves were published in a report by the U.N. Secretary-General on September 6, 2001—about nine months after President Bush took office and only days before the September 11 th terrorist attacks dramatically altered U.S. foreign policy priorities. The U.S. commitment to the MDGs during the Bush Administration was nuanced. As explained by a 2005 State Department cable to all U.S. embassies and USAID missions, the United States agreed to the development goals included in the Millennium Declaration adopted at the 2000 U.N. Millennium Summit. It did not, however, commit to the goals, targets, and indicators issued by the U.N. Secretariat in 2001. These are the eight goals and related indicators that are generally referred to today as the MDGs, but were described by the State Department as "solely a Secretariat product, never having been formally adopted by member states." The Bush Administration did not fully accept the Secretariat's formulation of the MDGs for two primary reasons. First, it argued that the Secretariat took the MDGs out of the context of the Millennium Declaration, which included commitments to good governance, democracy, human rights, and other U.S. foreign policy priorities. Second, one of the indicators established by the Secretariat for MDG 8 (developing global partnerships for development) is efforts by developed countries to provide 0.7% of their gross national income (GNI) as official development assistance (ODA). The United States, which is the leading bilateral ODA donor in dollar terms, but not when ODA is measured as a percent of GNI, has generally opposed numeric aid targets, arguing that they do not reflect developing country needs or capacity to absorb aid. These elements together, U.S. diplomats assert, turned the "development discussion into an ODA discussion." As a result of this ambiguity, many Bush Administration documents and texts negotiated at international fora replaced blanket endorsements of Millennium Development Goals with phrases such as "internationally agreed to development goals, including those in the Millennium Declaration," to connote agreement with the idea of the MDGs, but also to reserve room for debate on how they were to be achieved. Administration officials also emphasized that while the Millennium Declaration established important goals, the Monterrey Consensus (the product of the U.N.-sponsored International Conference on Finance for Development in 2002) provided the strategy to meet global development priorities. The Monterrey Consensus, unlike the MDGs, focused on economic growth as the foundation for sustainable development, and emphasized good governance, country ownership of development strategies, trade, and private investment. It was in the context of the Monterrey Consensus, not the MDGs, that the Bush Administration pledged significant increases in U.S. ODA. The Monterrey Conference was also the backdrop for President Bush's announcement of a new U.S. global development funding mechanism, the Millennium Challenge Corporation (MCC), which seeks to fund the development needs of countries that have demonstrated relatively good governance, a commitment to economic freedom, and investment in their citizens. A 2008 policy statement on the U.S. commitment to the MDGs highlighting the Bush Administration's strategy focused on (1) country ownership and good governance, (2) pro-growth economic policy, (3) investing in people, and (4) addressing failing and fragile states. It did not specifically mention any of the MDGs, and identified the Monterrey Consensus as the basis of the U.S. strategy. Given that the MDGs closely relate to long-standing U.S. development assistance priorities such as improving access to healthcare, education, and economic opportunity, it is hard to identify any specific impact the Millennium Declaration had on U.S. policy during the Bush Administration. On the other hand, U.S. ODA trends in these years were largely consistent with MDG commitments, with total U.S. ODA almost tripling between 2000 and 2008, from $9.95 billion to $26.84 billion. The President's Emergency Plan for AIDS Relief (PEPFAR) accounts for a large part of the funding growth and has unquestionably advanced MDG 6, combating HIV/AIDS, malaria, and tuberculosis. At the same time, a good portion of the growth in foreign assistance during the same period was directed toward the Middle East and South and Central Asia, likely reflecting strategic interests related to the wars in Iraq and Afghanistan more than commitment to the MDGs. President Obama, who stated during the 2008 presidential campaign that under his leadership the MDGs would be America's goals, appears to have elevated the significance of the MDGs relative to his predecessor. Administration officials no longer carefully distinguish the goals of the Millennium Declaration from the MDGs. President Obama's National Security Strategy states that "the United States has embraced the United Nations Millennium Development Goals," and Congressional Budget Justifications for Foreign Operations submitted under the Obama Administration frequently discuss attainment of MDGs in conjunction with U.S. development policy goals. The Obama Administration's four major foreign assistance initiatives appear to reflect consideration of the MDGs. The Obama Administration's Feed the Future Initiative is aimed at ending hunger (MDG 1). The Global Health Initiative (GHI) focuses not only on HIV/AIDS, malaria, and other diseases (MDG 6), but also on child mortality (MDG 4) and maternal health (MDG 5). The Global Climate Change Initiative targets environmental sustainability (MDG 7) and the Global Engagement Initiative, designed to create economic opportunities and security in Muslim communities abroad, is intended to support entrepreneurship and create jobs through collaborative partnerships (MDG 8) and involve women in the social and economic development of their communities (MDG 3). The Obama Administration's published strategy for meeting the MDGs, like the Bush Administration strategy, does not focus on specific MDGs, explaining that "we do not treat the MDGs as if they were separate baskets" and "the purpose is to emphasize that the MDGs are all connected." Rather, it identifies four "imperatives"—(1) innovation, (2) sustainability, (3) measuring outcomes rather than inputs, and (4) mutual accountability among donor and recipient countries—and discusses ways that U.S. agencies apply them. The strategy appears intended to demonstrate to the international community a greater U.S. interest in the MDG discussion, while maintaining the U.S. position that the MDGs can best be achieved by focusing on cross-cutting aid effectiveness issues rather than funding targets. Like his predecessor, President Obama has not embraced the target associated with Goal 8, which calls for donor nations to reserve 0.7% of their GNI for development aid. At the September High-level Meeting, President Obama announced a new U.S. global development strategy, which the Administration is referring to as the Presidential Policy Directive on Global development (PPD). The pillars of the PPD reflect the imperatives detailed in the U.S. Strategy fo r Meeting the Millennium Development Goal s . They emphasize the need for development assistance to be judged by its impact rather than volume, and to promote sustainable improvement rather than dependency. The President highlighted the role of diplomacy, trade, and investment in development, arguing that aid alone is not effective. Like his predecessor, he also emphasized the importance of broad-based economic growth and mutual accountability. In regard to the latter, he reassured developing countries that the United States would meet its commitments and encouraged other donors to do the same, but stated that ultimately developing countries must take the lead in their own development. The PPD, like the U.S. Strategy for Meeting the Millennium Development Goals , does not appear to be a significant departure from the Bush Administration approach. Experts noted, however, that the decision to announce the new policy in the context of the MDG High-level Meeting indicates a desire to improve the working relationship between with United States and the U.N. on development issues. The President made no new financial commitments in his speech. Over the course of the Meeting, however, Secretary of State Hillary Clinton announced a $50.82 million U.S. commitment for the Global Alliance for Clean Cookstoves, and a partnership with the United Kingdom, Australia, and the Bill & Melinda Gates Foundation to improve access to family planning services in South Asia and Sub-Saharan Africa. Both announcements were made in the context of promoting the U.N. Secretary-General's Global Strategy for Women's and Children's Health , but are consistent with U.S. efforts already underway as part of the Administration's Global Health Initiative. By signing the outcome document, the Administration also renewed the U.S. commitment to supporting dozens of broadly stated "best practices" related to each MDG. Of particular interest to Congress in the wake of the Meeting may be the President's statement on the need for greater selectivity and division of labor among aid donors, and his pledge to work with Congress to ensure that U.S development assistance more closely reflects recipient country priorities. The legislative record indicates little congressional action on the MDGs since 2000. The MDGs have scarcely been mentioned in appropriations legislation and accompanying reports over the last decade, which have largely shaped foreign assistance policy in the absence of regular foreign assistance re-authorization legislation. Two pieces of legislation have been introduced that address the MDGs as a whole. Introduced in the 109 th Congress, the International Cooperation to Meet the Millennium Development Goals Act of 2005 ( S. 1315 ) called for U.S. leadership on the MDGs, and required the Department of State to submit a report to Congress detailing global progress toward the MDGs and how U.S. policy and actions had contributed to such progress. The bill passed the Senate by unanimous consent, but was held at the desk. On September 16, 2010, Representative Barbara Lee introduced H.Con.Res. 318 , expressing support of the "ideals and objectives" of the MDGs and urging the President to "ensure the United States contributes meaningfully to the achievement of the Millennium Development Goals by the year 2015." Introduced just days before the September High-level Meeting, the resolution never received committee or floor consideration. However, a hearing on "Achieving the United Nations' Millennium Development Goals: Progress Through Partnership," held by the House Subcommittee on International Organizations, Human Rights and Oversight on July 27, 2010, indicated congressional interest in the MDGs in the lead-up to the High-level Meeting. Furthermore, a handful of bills have been introduced that refer to specific Goals. The Global Poverty Act, for example, introduced in the House and Senate in both the 110 th and 111 th Congresses, calls for a strategy to meet MDG 1. Then-Senator Obama was the Senate sponsor of that legislation in the 110 th Congress. In the 111 th Congress, the House Foreign Affairs Committee (HFAC) and the Senate Foreign Relations Committee (SFRC) focused on reforming U.S. foreign assistance and re-writing the Foreign Assistance Act of 1961 (FAA), which is the legislative basis for most foreign aid programs. These efforts did not reflect any specific MDG influence, though many of the stated goals could have been interpreted to align with MDGs. Neither of the major reform bills in the 111 th Congress, H.R. 2139 and S. 1524 , specifically mentioned the MDGs, nor did any of the discussion papers made public by HFAC as part of the effort to re-write the FAA. Ten years after the Millennium Declaration, government officials and development advocates are reviewing a decade of implementation efforts to determine how lessons from the past can help shape policies that promote more effective development in the future, whether through achievement of the MDGs or revision of the MDG approach. As President Obama said at the High-level Meeting, "if the international community just keeps doing the same things the same way, we may make some modest progress here and there, but we will miss many development goals." These efforts raise issues that are central to Congress's role in funding and overseeing U.S foreign assistance. Key policy issues include the practicality of the Goals, the role of foreign assistance in achieving the Goals, selectivity in the provision of aid, and accountability. Given the uneven progress in achieving the MDGs to date, some in the policy community have questioned the role of the Goals in global development efforts and their overall effectiveness. One of the primary issues raised in this context is the practicality of the Goals. Many argue that the MDGs provide unrealistic expectations for regions or countries, particularly those starting out at a lower economic threshold than others (such as Sub-Saharan Africa). For example, many contend that MDG 2, which calls for all countries to achieve universal primary education by 2015, is unrealistic for many poor countries because it asks them to achieve in 15 years what other countries have taken over a century to attain. Such unrealistic expectations, critics argue, set countries up for failure. In the same vein, some are concerned that the idealistic or utopian aspects of the MDGs may detract from actual development successes. For example, a country may achieve historic (but not universal) increases in primary school enrollment or access to reproductive health, but technically "fail" to achieve MDGs 2 and 5. Critics argue that rather than being branded as failures for not achieving the MDGs, countries should be applauded for their achievements. As expected, debate over appropriate aid levels was at the heart of the discussions held at the High-level Meeting in September. Many aid advocates, particularly representatives of aid-recipient countries, assert that lack of progress on the MDGs can, in many instances, be attributed to insufficient levels of aid and they encouraged donor countries at the Meeting to commit to higher aid levels. Others contend that there is little evidence indicating that higher aid levels lead to greater development impacts, and that many developing countries have demonstrated an inability to use aid effectively. Some even argue that aid can be counterproductive to development, as it can distort economic incentives, flood capacity, and create dependency. The lack of consistent and reliable monitoring and evaluation of development assistance programs results in inconclusive data, leaving the debate unresolved. This issue of aid volume versus aid effectiveness is central not only to discussions related to the MDGs but also to U.S. foreign aid policy. The U.S. delegation at the High-level Meeting downplayed calls for more aid, focusing instead on aid effectiveness and on the role of non-aid tools of development, such as trade and investment. The MDG global action plan from the High-level Meeting called on governments to fulfill their aid commitments, but did not include new commitments. Nevertheless, stakeholders may pressure Congress to increase foreign aid appropriations to reflect the needs highlighted in the action plan produced by the summit. A common criticism of the MDGs is that they try to accomplish everything at once, and are therefore so impractical as to be useless. Given the lingering effects of the global financial crisis, and accompanying fiscal constraints, members of Congress may feel a greater need than ever to prioritize U.S. development assistance. Efforts have been made by NGOs at the international level, most notably through the Copenhagen Consensus project, to help policymakers prioritize various development challenges based on estimated costs and benefits. The Obama Administration has stated that selectivity and division of labor among donors are an important emphasis of the new development strategy it announced at the High-level Meeting. Prioritizing programs, however, can be challenging in many respects. Virtually all development activities have strong supporters both in the United States and globally who can make selectivity politically difficult. Furthermore, as the U.S. MDG strategy statement emphasizes, many development activities are interrelated. For example, the Bush Administration focused foreign assistance resources heavily on HIV/AIDS prevention and treatment, making tremendous gains in the number of people who had access to antiretroviral drugs and in preventing the transmission of HIV/AIDS to many newborns. Many global health experts contend, however, that this progress on HIV/AIDS has come at the expense of basic healthcare, education, and nutrition, all of which are essential to ongoing efforts to stop the spread of HIV/AIDS and extend the survival of those infected with HIV. Some experts attribute limited advancement toward the MDGs to the absence of accountability stipulations. If a government or aid program does not deliver on its promises, whether due to poor design, corruption, or other factors, the intended recipients generally have no recourse. Attempts have been made at the international level to address this problem. The Paris Declaration on Aid Effectiveness, for example, has goals and indicators against which individual donor and recipient country progress is monitored and reported on a regular basis. The MDGs, however, are silent on the issue of donor and recipient country responsibilities in achieving the Goals. Congress has repeatedly emphasized accountability and the need for greater monitoring and evaluation as part of foreign aid reform, and the Bush and Obama Administrations have been consistent in asserting that mutual accountability and evidence of impact are central to U.S. development policy. The global action plan on the MDGs agreed to at the September High-level Meeting addresses accountability in broad terms, but breaks no new ground on the issue. While evidence of MDG effectiveness in advancing global development is uneven a decade after the adoption of the Millennium Declaration, the international community, including the United States, continues to use the Goals as a paradigm for development assistance. The September High-level Meeting, and the negotiations that preceded it, were an opportunity for the United States to both demonstrate commitment to the Goals and lead the global development assistance discussion toward a greater emphasis on accountability, good governance, sustainability of development programs and other priorities consistent with both U.S. foreign policy and lessons learned over the first 10 years of efforts to achieve the MDGs. 

Summary: From September 20 to 22, 2010, heads of state and government convened at United Nations (U.N.) Headquarters for a High-level Plenary Meeting to review progress toward the U.N. Millennium Development Goals (MDGs). The MDGs are a group of measurable development targets agreed to by 189 U.N. member states—including the United States—as part of the 2000 Millennium Declaration. The Goals, which governments aim to achieve by 2015, include (1) eradicating extreme hunger and poverty; (2) achieving universal primary education; (3) promoting gender equality and women's empowerment; (4) reducing the under-five child mortality rate; (5) reducing the maternal mortality rate; (6) combating HIV/AIDS and other diseases; (7) ensuring environmental sustainability; and (8) developing a Global Partnership for Development. Since 2000, governments have worked to achieve the MDGs with mixed results. Experts generally agree that while some MDGs are on track to be met, the majority of Goals are unlikely to be achieved by 2015. Many have also found that progress toward the Goals is unevenly distributed across regions and countries. India and China, for example, have made considerable progress in achieving the MDGs, while many countries in Africa have failed to meet almost all of the Goals. President Barack Obama supports the MDGs and attended the September High-level meeting. In July 2010, the Administration published The United States' Strategy for Meeting the Millennium Development Goals, which identifies four "imperatives" for achieving the Goals—innovation, sustainability, measuring outcomes, and mutual accountability. Members of the 112th Congress may be interested in the MDGs and the September High-level meeting from three primary perspectives. First, Congress may wish to consider the MDGs in the context of authorizing and funding broader U.S. development assistance efforts. Second, members may wish to be aware of the commitments made by the United States at the High-level meeting. Additionally, Congress may consider conducting oversight of international progress toward the MDGs, including U.S. efforts and the future of the Goals. While evidence of MDG effectiveness in advancing global development is uneven a decade after the Millennium Declaration, the international community—and many policymakers in the United States—continue to use the Goals as a paradigm for development assistance. This raises a number of overarching questions for Congress about the role and future of the MDGs, including In what areas, if any, have the MDGs been successful? Are the MDGs practical? What is the role of U.S. foreign aid in the MDGs? Who is accountable for MDG progress? This report will be not be updated further.