Leave no child behind: Moving the agenda forward

By Nicola Pearson, Shannon Marie Harmon Most of the world now recognises that only by...

By Nicola Pearson, Shannon Marie Harmon

Most of the world now recognises that only by creating an environment in which children can reach their full potential can the poorest children compete as adults on a more level playing field.

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Global progress to protect children, underpinned by the Millennium Development Goals (MDGs), means that children born today are roughly 40 per cent more likely to survive to their fifth birthday than those born in 2000, less likely to live in poverty and more likely to be in school.

Mortality rates for under-5 year olds by country (2015)

Hover on the interactive map above to explore and Click here to expand

Since 2000, 24 low- and lower-middle-income countries – including Ethiopia, Liberia, Malawi, Mozambique and Niger – have achieved the goal of reducing their under-five mortality rate by two-thirds.

If the trends of the MDG-years continue, however, by 2030 an estimated 167 million children, the majority in sub-Saharan Africa, will still be living in extreme poverty.

Nearly two hundred million children will be denied opportunities to complete school, and children from the poorest households will remain the most likely to die from preventable causes, such as disease and malnutrition.

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Preterm birth complications still kill the most infants, with Pneumonia second, accounting for 16 per cent of child deaths under five.

The transition to the Sustainable Development Goals (SDGs) last year recognised that, despite progress such as reducing under-five mortality by two-thirds, too many vulnerable children are left behind by the movements designed to protect them.

UNICEF research highlights that despite the success of low-come countries in reducing child mortality rates, such as Malawi, Pakistan and Nigeria, reducing internal inequity has been less successful. Faster results can often be achieved by targeting richer communities, meaning the survival gap between rich and poor children actually widens.

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Limited economic growth does not mean under-5 mortality rates cannot be reduced

Annual rate of reduction in under-five mortality, 2000–2015, and annual rate of change in GDP, 2000–2014, by country. Bubble size/colour shows under-5 mortality rate in 2015. Hover on the interactive map above to explore and click here to expand

Data surveyed in 51 high-mortality counties shows that in terms of percentages, more children’s lives are saved by concentrating on the poorest communities.

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Gender inequality

Discrimination within countries also means that poor girls living in rural areas still tend to have the least access to education, with ethnic origin and disability pushing some further down the order. Girls who receive no education are also up to six times more likely to be married as children than girls educated to secondary school level.

With married girls among the world’s vulnerable people, lack of education consequently impacts maternal and therefore child health.

Child marriage affects 15 million children a year and steals away childhood, consequently impacting maternal health and therefore child health

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Education can also protect girls from early marriage. Those who receive little or no education are up to six times more likely to be married as children than girls who have secondary schooling. Married girls are among the world’s most vulnerable people.

Global emphasis on economic growth

Although initiatives such as conditional and unconditional cash transfers, generally acknowledged as reducing the poverty gap, depend on huge financial commitments from governments, improving the lives of children isn’t always synonymous with the global focus on economic growth.

India and Nigeria, for example, are both experiencing rapid economic growth, but have both been slow to reduce child mortality.

In Nepal, one of the poorest countries in the world, lower cost impact has been achieved by communities working with civic authorities to improve sanitation by creating 27 open defecation-free districts, while teams of female volunteers have drastically reduced maternal mortality by working with health workers to reach some of the country’s most marginalised areas

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In terms of education, as demonstrated by the explosion of primary enrolment in sub-Saharan Africa, more money, in itself, does not necessarily result in better learning outcomes. More important is the way resources are allocated to ensure quality of teaching and to reach the most vulnerable.

Towards a universal index

Working towards the pledge of the SDGs to leave no-one behind and to reach the furthest, the challenge for policymakers is that above and beyond the basic fight for survival, there is no universal index by which to measure child wellbeing and to hold governments accountable.

Once basic survival is assured, other more subjective indicators define wellbeing, such as life satisfaction, cultural identity, civic participation and resilience. Obesity and mental health have become priorities in richer countries, and in countries struggling to recover from financial recession, parental unemployment, loss of income and eviction from the family home negatively affects children’s lives.

Where one in three internet users are now children, higher in low income countries, access to technology becomes a priority for children searching online for advice, particularly where there is nowhere else to go for help.

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Just as we might think we are nearing a consensus to define wellbeing, the ground shifts. UNICEF estimates that nearly 50 million children have migrated across borders or been forcibly displaced in recent years, many simply falling off the radar. The World Health Organisation has predicted a quarter of a million additional deaths each year from malaria, diarrohea and heat stress caused by climate change.

Sarah Cook, director of the UNICEF Office of Research-Innocenti, says, “Each new global crisis risks setting back child welfare. The difficulty for policymakers is how to conceptualise invisible issues such as climate change and migration, and raise them to macro level.”

Moving forward

Equity begins by identifying who is being left behind and why, but with the births of nearly one in four children under five-years old never being recorded and a lack of a standardised methods for collating and reporting the data that does exist, evidence cannot be translated into policy.

When it comes to priorities, Cook says the challenge is also how to integrate the immediate needs of, say, sustainable nutrition and clean water with science-based research such as epigenetics and the effects of stunting on brain development into one coherent narrative that informs policy.

The success of the 2030 agenda for sustainable development depends on how commitments are delivered for and with children, and prioritising the voices of those not even on the radar. Ultimately, an ageing population, facing its own problems and with the benefit of a vote, could otherwise begin to force children off the agenda.

This piece was produced by SciDev.Net’s Global desk.
This article is supported by CIFAR. The institute convened a Forum on the Well-Being of the World’s Children in London November 17-19.



A fair chance for every child, UNICEF, 2016.
Climate change and health, World Health Organization, 2016.


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