State of The World's Mothers 2009: Investing in The Early Years, May 2009

State of the world’s mothers 2009
Investing in the Early Years

Contents
2 Foreword by Cokie Roberts

3 Introduction by Charles F. MacCormack
5 Executive Summary:
Key Findings and Recommendations
9 Millions of Young Children Are Not
Prepared to Succeed in School
13 The Power of Early Childhood Development
to Change the World
17 School Success Index for Developing Countries
25 School Success Index for the United States
31 Early Childhood Development Report Card
for Wealthy Countries
35 Keeping Young Children Healthy, Safe and Learning
41 Take Action Now for the World’s
Youngest Children
43 Appendix: Tenth Annual Mothers’ Index
and Country Rankings
47 Methodology and Research Notes
52 Endnotes
Front cover:
Santoshi (right) and Analji
(left) learn to write letters in a
preschool class supported by
Save the Children in the far-
western region of Nepal. Santoshi
says she likes coming to school,
and when she grows up, she
wants to be a teacher.
Photo by Brent Stirton
© Save the Children, May 2009
All rights reserved.
ISBN 1-888393-21-1 el salvador •
2 | State of the World’s Mothers 2009

Investing in the
Early Years
In commemoration of Mother’s Day, Save the Children is publishing its tenth annual
State of the World’s Mothers report. Focusing on the critical importance of children’s experiences in
their early years, this report suggests specific activities mothers and caregivers can do with their
young children to help them reach their full potential in school. The report highlights the urgent need
to reach 75 million children worldwide who fail to complete primary school as well as the 2.5 million
fourth graders in the United States who are not reading at grade level. It shines a spotlight on places
where children have the best chance to succeed in school and shows that effective solutions to early
education challenges are affordable – even in the poorest communities.
Save the children | 1

Foreword
McKenzie is headed in the right direction. Her mom,

Betty Sue, dotes on her and is ready to listen to Vetta Kidd,
a friendly young woman who comes to visit the baby
regularly as part of Save the Children’s early childhood
effort. Vetta is from the area, known to the folks who live
on the hills and in the hollers of this community. The local
health clinic was happy to identify pregnant girls who would
need help as new moms, allowing Vetta to start her work
before birth.
Once the baby arrives, Vetta keeps the mother on track,
promoting breastfeeding, checking on immunizations and
providing hints on playing with the newborn. Things that more
affluent mothers do almost instinctively – identifying body
parts, singing to the baby, reciting rhymes and reading stories
– all are new ideas in some poorer households. In her visits,
Vetta brings age-appropriate toys and books, books, books to
these homes where they are often completely absent.
Betty Sue also goes regularly with other moms to the
local school, to meet with teachers who will make sure
• kentucky McKenzie is ready for school when the time comes. When
McKenzie is 3, the home visits will be replaced by monthly
Take one step into baby McKenzie’s chaotic house in Owsley visits to the by now familiar school where the little girl will
County, Kentucky and you see why community care for the go home with a fresh bag of books every month. By the time
youngest of babies is essential. Without help, this bright- she starts school, she should be as prepared as children in
eyed 4-month-old would likely go to school unprepared and the most affluent areas of the country.
fall quickly behind – as two-thirds of our fourth graders do The research is astounding. Children who participate in
in the United States. Save the Children’s Early Steps to School Success program as
Baby McKenzie lives with her single, teenage mom, a babies and toddlers score better than the national average
teenage aunt and her grandparents in a county where the for language development. And one of the main reasons
median family income just topped $17,500 in 2005. No one the children do so well is that their mothers are involved,
in the household has a job. Working with the local school and will likely stay involved. We’ve learned that emphasizing
district, Save the Children is fighting for McKenzie’s future – the health, education and participation of mothers works
and we’re doing this not only for children here at home, but both in America and in dozens of poor countries where
for children around the world. Save the Children operates.
Seventy-five million children in the world don’t get a That’s why, every year, though we are an organization
basic primary school education. We at Save the Children, dedicated to children, we take a look at the State of the
where I serve as a trustee, are determined to help provide World’s Mothers. This report shows what a difference it
all children – whether in Appalachia or Africa – a positive can make if we invest early – making a commitment to
start in life with loving home care, opportunities to learn mothers and their young children can change a country. It
and explore, and the chance to grow up to be anything they also shows how much more we need to do in so many poor
want to be. communities. But we can do it. We can ensure a healthy
Years of research prove that interventions early in life can start, and a promising future, for children everywhere.
help pull people up out of poverty. And they’re incredibly It’s a good news story.
cost-effective. In the U.S., $1.00 spent in the first 60 days of
life on nutrition programs alone saves up to $3.13 in health
care costs. Comprehensive early childhood development
programs can mean the difference between a taxpaying, Cokie Roberts
enterprising citizen and someone on the public dole or Author, News Commentator
occupying taxpayer-funded prisons. and Save the Children Trustee

Introduction
examines those states and countries that are succeeding

– and those that are failing – to prepare their children to
succeed in school. It calls attention to areas where greater
investments are needed and shows that effective strategies
are working, even in some of the poorest places on earth.
Second, Save the Children is encouraging action by
mobilizing citizens and organizations in the United States and
around the world to support early childhood development
and to advocate for better policies and increased funding for
proven programs.
Finally, we are making a major difference on the
ground. Save the Children is working in partnership with
government agencies and local organizations to deliver
innovative early childhood development programs in the
developing world and in poor communities in the United
States. We help parents to raise healthier children and to
begin preparing them for school success early in life. We
show preschool teachers and child care providers how to
create welcoming learning environments for young children.
All of Save the Children’s education programs emphasize the
• haiti importance of schooling for girls and active participatory
learning that strengthens students’ capacities to think
Every year, our State of the World’s Mothers report reminds creatively, solve problems, negotiate and resolve conflicts.
us of the inextricable link between the well-being of mothers We call on the world’s leaders to take stock of how
and their children. More than 75 years of experience on the mothers and young children are faring in every country.
ground have shown us that when mothers have health care, Investing in this most basic partnership of all – between
education and economic opportunity, both they and their a mother and her child – is the first and best step in
children have the best chance to survive and thrive. ensuring healthy children, prosperous families and strong
During the critical period in a child’s life from birth to communities.
age 5, the role of the mother is especially important. This is Every one of us has a role to play. Please read
when children’s bodies and brains are growing rapidly, when the Take Action section of this report, and visit
they begin to develop language skills, when the foundation www.savethechildren.org on a regular basis to find
for future health or sickness is established, and when lifelong out what you can do to make a difference.
approaches to learning and living with others are shaped.
This year’s report looks at how well children around
the world are faring during these formative early years. It
examines where families and communities are doing a good
job of preparing their children to succeed in school and in Charles F. MacCormack
life, and where they are setting up their children for failure President and CEO
on both fronts. It finds alarming numbers of children at risk Save the Children
of failure in primary school – both overseas and here in the
United States. And it shows how costly this failure will be to
society as a whole if we allow it to happen.
To address the early childhood development challenge,
Save the Children is working on three fronts:
First, Save the Children is increasing awareness of
challenges and solutions in early childhood development.
This report highlights the challenges that mothers and
families face as they juggle work, child-rearing and threats
brought on by poverty, AIDS, displacement and more. It

Executive Summary
Some 75 million children worldwide fail to complete primary young children a good start in life – and as a result 71
school, either because they drop out in the early grades or to 81 percent of fourth graders in the public schools in
because they never got the chance to attend school at all. In these states are not reading at grade level. Connecticut,
the United States, nearly 2.5 million fourth graders are not New Hampshire, Massachusetts, Vermont and Maine are
reading at grade level – this is 68 percent of all American the top five states where, generally speaking, parents and
fourth graders in public schools. communities are doing a better job of preparing children to
The cost to the world of this lost brain power is succeed in school. (To read more, turn to pages 25-29.)
staggering.
Early childhood – the period from birth to age 5 – is the
most critical period of growth and learning in a person’s
life. What happens – and what does not happen – during
these earliest years influences how the rest of childhood, Early Childhood Development:
adolescence and adult life unfold. When children receive A Snapshot
good quality care and learning opportunities in their earliest
years, they have a better chance to grow up healthy, to do Worldwide, 75 million children fail to complete
well in school, and to reach their full potential in well-being primary school, either because they drop out in the
and productivity. early grades or because they never got the chance to
State of the World’s Mothers 2009 looks at early childhood attend school at all.
education as a proven investment in economic prosperity,
social development and the survival and well-being of
children and their families. It presents two first-ever indexes, In the United States, nearly 2.5 million fourth graders
ranking 100 developing countries and 50 U.S. states based are not reading at grade level – this is 68 percent of all
on how well prepared their youngest children are to succeed American fourth graders in public schools.
in school. It examines economic data from around the world
showing that investments in early childhood pay off over
the long term. It also shows that tools and resources exist By age 3, roughly 85 percent of the brain’s core
to keep all children healthy, safe and learning, but that these structure is formed.
resources are not reaching the mothers and children who
need them most.
Because of poverty, poor health, insufficient nutrition
Key findings and deficient care, nearly 40 percent of all children
1) Early childhood care and development is a under age 5 in developing countries fail to reach their
proven and powerful investment in national well- potential in cognitive development. That’s more than
being and future economic prosperity. Research from 200 million children worldwide.
around the world consistently shows that investing in quality
early learning programs is one of the most effective ways to
improve children’s success in school, to increase incomes U.S. economists estimate that a strong investment in
and to reduce costs to society. In fact, the gains tend to be children’s development at the earliest stages would
the highest when early childhood investments target the yield returns as high as 15 to 17 percent per year in
youngest children and the most disadvantaged groups. (To better classroom performance, fewer health care
read more, turn to pages 13-15.) costs, higher workforce productivity, lower welfare
2) In the United States, an alarming number of costs and less crime.
children are at great risk of failure in school because
they are not getting the care and support they need
in their early years. New Mexico, Nevada, Mississippi, Internationally, economists estimate that each extra
Arizona and Alabama are the bottom five states where year of primary education will increase a person’s
young children face the greatest obstacles to success in future productivity by 10 to 30 percent, varying
school. These states scored low on indicators of parental country to country.
involvement, quality of home life and preschool participation.
Parents in these states are clearly struggling to give their
• NEPAL Save the children | 5

Executive Summary
3) Compared to other wealthy countries, the Recommendations

United States is losing ground in educational Child development experts – from local teachers to Nobel
attainment. The U.S. is falling behind in the resource Prize winners – are telling the world about the critical
that matters most in the new global economy: human importance of investing in the first five years of children’s
capital. Four decades ago, America had the best high school lives. But with few exceptions, the political will to take action
graduation rate in the world, but by 2006 it had slipped for mothers and young children is the missing ingredient
to 18th out of 24 industrialized countries. As recently as in this proven recipe for success. To help ensure more
1995, the U.S. was still tied for first place in the proportion children succeed in school and in life, Save the Children has
of young adults with a college degree, but by 2000 it had developed the following recommendations:
slipped to 9th place, and by 2006 to 14th place. The United 1) Invest in better health care for mothers and
States also has one of the highest college dropout rates in young children. The links between good health and
the industrialized world – 53 percent of Americans who nutrition and healthy brain development have been well
enter college do not finish. (To read more, turn to pages documented. Good care for young children must begin
31-33.) with care for pregnant mothers, ensuring that they are
4) In the developing world, nearly 40 percent adequately nourished, free from infections and exposure
of all children under 5 fail to reach their potential to harmful substances, and monitored for complications
in cognitive development because of poverty, during pregnancy. Prenatal and postnatal care should include
poor health and nutrition and deficient care. Chad, counseling to encourage a safe birth, awareness of danger
Afghanistan, Burundi, Guinea-Bissau and Mali are the bottom signs that require immediate attention, a plan for going to
five countries where children are most likely to miss out a skilled health care provider, counseling on how to care
on primary school. In these countries, dire poverty, lack for the newborn, and help to ensure breastfeeding. Health
of public services and conflict stack the odds against the outreach strategies and funding must do a better job of
youngest children. Approximately 1 child in 5 in these targeting the poorest and most marginalized mothers
countries does not even survive to age 5, and those who do and children in every country. More funding is needed for
often suffer from cognitive and physical impairments that wellness, prevention and family planning, as well as for
limit their development and productivity. In Burundi, 25 staffing, transport, equipment, medicine, health worker
percent of primary school-aged children are not attending training and the day-to-day costs of operating health
school. In Mali, Chad and Guinea-Bissau, 37, 40 and 55 systems. Health care for young children should start in
percent are not in school. Cuba, Armenia, Cyprus, Chile the home, where many of the simplest ailments can be
and Azerbaijan are the top five developing countries where successfully prevented or treated by informed parents,
children are better prepared to succeed in primary school. supported by community-based health outreach workers.
(To read more, turn to pages 9-11 and 17-23.) (To read more, turn to pages 35-39.)
5) The future of humankind will be defined by 2) Provide coaching and information to help new
how well mothers today are able to raise the next mothers and fathers give their young children the
generation. A mother’s influence on her child’s cognitive best possible chance to succeed. Parents are the most
development begins before the child is born. Her education influential people in a young child’s life, and when they are
level, health, nutritional and economic status all impact the equipped with better child-raising tools and techniques
well-being of her child from the moment it is conceived. It is they can often do wonders. Many successful programs
often said that a mother is her child’s first and best teacher. in developing and industrialized countries have improved
Yet mothering, in many ways, has never been so difficult as outcomes for children by teaching new moms and dads to
it is in today’s global world, and possibly never so isolated, be better parents. This can be done through home-based
unsupported and undervalued. Mothers around the world coaching, community support groups and classes outside
are solving child care challenges as best they can, but millions the home. In addition to breastfeeding and basic health
of the poorest mothers and caregivers need help to access care, these programs encourage parents to feed their
tools, information and support to give their children the best children more nutritious food, to interact more with their
possible future. (To read more, turn to pages 9-15 and 43-46.) children, to create a learning environment in the home, to
reduce stress in the family and to discipline without hitting.
Parenting coaches can also serve as a critical first line of
defense against child abuse and neglect, intervening on

The 2009 Mothers’ Index:
Sweden Tops List, Niger Ranks Last,
United States Ranks 27th
Save the Children’s tenth annual Mothers’ Index

compares the well-being of mothers and children
in 158 countries – more than in any previous year.
The Mothers’ Index also provides information on an
additional 15 countries, 7 of which report sufficient
data to present findings on children’s indicators. When
these are included, the total comes to 173 countries.
the child’s behalf when necessary and rallying community Sweden, Norway and Australia top the rankings
resources to safeguard the child. (To read more, turn to this year. The top 10 countries, in general, attain
pages 35-39.) very high scores for mothers’ and children’s health,
3) Improve training and support for early child educational and economic status. Niger ranks last
care providers and preschool teachers. Good child among the 158 countries surveyed. The 10 bottom-
care is an extension of good parenting. The quality of early ranked countries – seven from sub-Saharan Africa –
childhood education outside the home depends on the are a reverse image of the top 10, performing poorly
ability of the caregiver to provide a secure, consistent, on all indicators. The United States places 27th again
sensitive, stimulating and rewarding environment. To this year.
be successful, early child care and preschool facilities – Conditions for mothers and their children in
whether center, community or home based – should have the bottom countries are grim. On average, 1 in 24
sufficient numbers of staff for the number of children, and mothers will die from pregnancy-related causes. More
the caregivers should be well trained, well supervised and than 1 child in 7 dies before his or her fifth birthday,
well paid. In addition, every effort should be made to retain and over 1 child in 3 suffers from malnutrition. Forty
caregivers so that they are consistent, familiar and reassuring percent of the population lacks access to safe water
figures in children’s lives. (To read more, turn to pages 35-39.) and only 4 girls for every 5 boys are enrolled in
4) Expand early learning opportunities for primary school.
children affected by AIDS, conflict and natural The gap in availability of maternal and child health
disasters. In communities destabilized by these crises, services is especially dramatic when comparing Swe-
young children often need special attention. Governments den and Niger. Skilled health personnel are present at
and NGOs can help by creating “safe spaces” and alternative virtually every birth in Sweden, while only 33 percent
child care arrangements where young children benefit from of births are attended in Niger. A typical Swedish
a secure environment and a return to comforting routines. woman has almost 17 years of formal education and
Through play, games, songs, art and other activities, will live to be 83 years old, 65 percent are using some
children can process their emotions under the guidance of modern method of contraception, and only one in
sympathetic adults, and begin to turn their lives around. (To 185 will lose a child before his or her fifth birthday. At
read more, turn to pages 38-39.) the opposite end of the spectrum, in Niger, a typical
5) Increase government support for proven woman has little more than 3 years of education and
early childhood development solutions in the will live to be 56. Only 5 percent of women are using
United States and around the world. Governments modern contraception, and 1 child in 6 dies before
everywhere should invest in early childhood development his or her fifth birthday. At this rate, every mother in
(ECD) programs and create plans of action to expand Niger is likely to suffer the loss of a child.
ECD programs and improve related policies. The United Zeroing in on the children’s well-being portion of
States should demonstrate leadership toward the goal the Mothers’ Index, Sweden finishes first and Niger is
of “Education for All” by providing $1 billion for basic last out of 165 countries. While nearly every Swedish
education in developing countries – including support for child – girl and boy alike – enjoys good health and
early childhood development – and $900 million for child education, children in Niger face a 1 in 6 risk of dying
survival programs to provide critical health care to children before age 5. Forty-four percent of Niger’s children
under 5. The United States should also do more to help are malnourished and 58 percent lack access to
the youngest children in need here at home by considerably safe water. Only 51 percent of children in Niger are
increasing funding for Early Head Start in fiscal year 2010, enrolled in primary school, and within that meager
and doubling funding for the Child Care Development Block enrollment, boys outnumber girls 4 to 3.
Grant. (To read more, turn to page 41.) These statistics go far beyond mere numbers. The
human despair and lost opportunities represented in
these numbers demand mothers everywhere be given
the basic tools they need to break the cycle of poverty
and improve the quality of life for themselves, their
children, and for generations to come.
See the Appendix for the Complete Mothers’ Index and Country Rankings.

Millions of Young
Children Are Not
Prepared to Succeed
in School
Worldwide, 75 million children fail to complete primary What do young children need
school, either because they drop out in the early grades or to succeed?
because they never got the chance to attend school at all.1 Research shows that 85 percent of brain growth occurs
In the United States, nearly 2.5 million fourth graders are in the first three years of life.7 What happens – and what
not reading at grade level – this is 68 percent of all American does not happen – in a child’s first days, months and years
fourth graders in the public schools.2 determines how well the brain grows, how language skills
develop, and shapes lifelong approaches to learning and living
Who are these children? And why are with others.
they not learning? When babies and toddlers get the encouragement,
The vast majority of the children who do not succeed stimulation and emotional attachment they need in the early
in primary school come from very poor families and years, their brain cells multiply and organize into high-
communities. They live in the least-developed countries of functioning engines for future learning and growth. When
the world, or in pockets of poverty within economically children have poor experiences in the earliest years – when
advanced countries. Almost half (47 percent) live in sub- they are exposed to fewer sights and sounds, less touch,
Saharan Africa and 24 percent live in South and West Asia. 3 less interaction with adults and less language – they actually
More than half (55 percent) are girls, and girls are far more develop smaller brains and lower IQs.8
likely than boys to never attend school at all.4 If young children experience long-term starvation,
The children who are missing out on primary school abuse or neglect, their brain development will be further
often have a variety of risk factors stacked against them. compromised. Poor nutrition and ill-health can begin in the
Besides being poor, their parents typically have little or no prenatal period, if a child’s mother is herself unhealthy and
education. Often their mothers are very young, and in some malnourished. If the family is impoverished, it is likely the
countries she is likely to be a single mother. These children child will suffer from inadequate diet and health care. When
tend to live in isolated rural areas, where there are few if any parents lack the wherewithal to provide a safe and nurturing
government services. Family resources tend to be scarce, home environment, children often fail to develop the
and as a result young children’s nutrition and health care essential foundation of confidence, self-control, and capacity
suffer. to communicate and cooperate that is needed for success in
The early formative years of life are critical to a child’s school and in life. If there is violence in the home or conflict
future well-being and productivity. Yet tragically – because in the community at large, the traumatic consequences for
of poverty, poor health, insufficient nutrition and deficient young children can be especially debilitating.
care – more than 200 million children under age 5 in It is, of course, never too late for children to improve in
developing countries fail to reach their potential in cognitive their health and development, to learn new skills, overcome
development. 5 This is almost 40 percent of all children in fears or change their beliefs. But more often, when children
this age group.6 And the cost to the world of this lost brain do not get the right start in life, they never catch up or reach
power is staggering. their full potential.
How Poverty and Ill-health Diminish a Child’s Brain Power in the First 5 Years
Mother
Poverty Stress/depression Poor care and
Low responsivity home stimulation
Low education
Mother & young child Failure in
Nutritional deficiencies/ primary school
infections
Poor cognitive, motor,

Stunted growth
socio-emotional development
In developing countries, an estimated 219 million children under 5 – Data sourced and diagram adapted from: Grantham-McGregor,
almost 40 percent of all children in this age group – fail to reach their Sally et al. “Developmental Potential in the First 5 Years for Children in
potential in cognitive development because of poverty, poor health Developing Countries,” The Lancet. 2007.
and nutrition, and deficient care.
• philippines Save the children | 9

How a Child’s Brain Develops and How a Mother Can Help
Age
1-3 Years 3-5 Years
· Provide writing instruments and · Engage in daily talking, storytelling,
Brain continues to 18 opportunities to practice singing, and read to the child in native
develop throughout · Provide other opportunities and language
the lifetime 17 objects for using hands · Practice pronunciation of different
16 · Provide obstacles to negotiate sounds in native tongue
(i.e. steps to climb, walking on simple · Involve child in daily activities
15 trails) that involve counting, sorting and
Higher Cognitive Functions 14 · Provide open spaces for pushing, identifying shapes
During this stage: kicking, running, dancing and jumping · Engage child in climbing and swinging
· Toddling begins, the first steps and 13 · Continue back and forth motions
unsteady movements 12 conversations · Provide experience with manipulable
· Coordination and agility increase · Establish reading routine objects
· Baby wants to explore surrounding 11 · Introduce letters and numbers · Provide high quality preschool
environment 10 · Model good behavior · Explore natural outdoor settings
· Exposure to adult world begins · Offer emotional reassurance and · Play games with rules
9 support taking on challenges · Encourage interaction with other
· Engage in early formal/informal children; create opportunities to
8
education for parents and child share and help
Brain is 95% of 7 · Provide opportunities to take
adult size responsibility and make choices
6
· Encourage creativity and self-
5 expression
· Establish routines (e.g. bedtime)
4
Years
3
2
Year 1 1
12
11 9-12 Months
Months
10 · Name things the baby hears and sees

· Tell the baby what is happening
9 · Dedicate time for the baby to practice
8 new motor skills
7
6 6-9 Months
5 3-6 Months · Comment on the baby’s activities
· Let the baby practice picking up food
· Breastfeed exclusively · Allow time for the baby to move on
4
· Place the baby in different positions its own
3 to help develop new skills like rolling, · Give explanations for items the baby
creeping and crawling is curious about
2
· Have back and forth “conversations” · Take note of the baby’s responses to
1 · Create a routine for the baby sounds, sights and activity
Birth 0
-1
0-3 Months
· Newborn and postnatal care
Sensory Pathways -2 · Breastfeed exclusively
(Vision, Hearing) -3 · Talk and sing to the baby
· Hold the baby
During this stage, the baby: -4 · Respond to the baby’s signals
· Begins to smile
-5 · Give the baby safe objects to explore
· Tracks people and objects with eyes
· Comfort the baby when he/she cries
· Prefers faces and bright colors -6 · Begin regular reading to the baby
· Reaches
· Discovers hands and feet -7
· Responds to sounds -8 Prenatal
Conception · Quality antenatal care
-9
· Basic preventive interventions
Language · Adequate nutrition, including supplementation
During this stage, the baby develops: · Avoid exposure to harmful chemicals
· Trust of others · Life skills assistance for expecting mothers and families
· Enjoyment · Skilled attendance at birth
· Bonding, attachment · Access to emergency obstetric care
· Cognition, prediction of events
The first years of a child’s life are marked by rapid cognitive, linguistic, social, emotional and motor development. By the time children are 3, their
brains have reached peak development in most areas. Although progress along these development pathways occurs simultaneously, they each peak
at different times. Because of this, children master different skills at different times and need different types of encouragement and activities to
match their developmental stages.
Sources: Pablo Stansbery, Expanding the ECD Menu of Services Beyond Classroom-Based Interventions (Draft CIES Conference Paper, Save the Children, March 2009); Honeywell,
Child Development Stages, http://customer.honeywell.com; Center on the Developing Child at Harvard University. A Science-Based Framework for Early Childhood Policy: Using
Evidence to Improve Outcomes in Learning, Behavior, and Health for Vulnerable Children, www.developingchild.harvard.edu; UNICEF, State of the World’s Children 2001; Rebecca
Parlakian and Claire Lerner, Your Baby’s Development, www.zerotothree.org; Rhoshel Lenroot and Jay Giedd, “Brain Development in Children and Adolescents: Insights from
Anatomical Magnetic Resonance Imaging,” Neuroscience and Biobehavioral Reviews, Volume 30, Issue 6, 2006, pp.718-729.
The mother-child connection enter the world at risk for lifelong physical, cognitive and
All babies need at least one person who is passionately behavioral disabilities that can have a profound effect on
devoted to them. Loving family members and caregivers can their school performance.9 Recent studies have found that
play this role – and many do in situations of parental illness, children who are born preterm or low birthweight tend
death or separation – but usually it is the mother who to have lower cognitive scores and problem-solving ability
matters most in a young child’s life. in their early years. And in their school years, they are
A mother’s influence on her child’s cognitive development more likely to be enrolled in special education classes, have
begins before the child is born. It is important for a mother attention-deficit disorder and other behavioral problems.10
to get proper nutrition when she is pregnant and good Breastfeeding can enhance the emotional bond between
prenatal care to reduce the chance that her baby will a mother and her child. It can also help protect the child
be born too early or too small. Low birthweight babies against developmental delays and improve language and

Millions of Young Children Are Not
Prepared to Succeed in School
motor skill development.11 Humans are the “thinking animal,”

and breast milk is formulated to build the human brain, Children of Better-Educated
just as other milks are formulated to build bones, speed or Mothers are more ready for School
sight – whatever is most important to a species’ survival.
The benefits of breastfeeding have been shown to be long-
100
lasting. One study found that breastfed children showed
90
higher levels of cognition up to age 15 (compared to children
80
Percentage of kindergartners
who were fed formula)12 and another documented higher
with school readiness skills

70
standardized test scores, teacher ratings and academic
60
achievement into young adulthood.13
50
It has often been said that a mother is her child’s first
40
and best teacher. So it goes without saying that a mother’s
30
level of education has a tremendous impact on whether
20
her children go to school, and how well they do in school.
10
Numerous studies show the close correlation between
0
mothers’ education levels and children’s school readiness Reading Mathematics Fine motor
in areas such as reading proficiency, math proficiency, fine proficiency proficiency skills
motor skills and emotional maturity.14

Mother did not finish high school
Mother has high school diploma/GED
Where Mothers Are Literate, Mother has some college, including vocational/technical
More Children Succeed in School Mother has college degree or more
A mother’s level of education greatly influences how well her

60 children do in school. One study in the United States looked
at the relationship between mothers’ education levels and the
Niger
percentage of first-time kindergartners who demonstrated
three positive indicators of school readiness: reading proficiency,
Primary school-age children out of school (%)
Burkina Faso
50
math proficiency and fine motor skills.
Source: Child Trends and Center for Child Health Research (2004). Early
Child Development in Social Context. Data from: K. Denton,E. Germino-
40 Chad Hausken, and J. West (project officer), America’s Kindergartners, NCES
Mali
Nigeria
2000-070, (Washington: U.S. Department of Education, National Center for
Pakistan Education Statistics: 2000)
30
Ethiopia
20
Mozambique
In the developing world, many mothers have no education
Bhutan Mauritania
at all, and their children are on average twice as likely to
be out of school compared to those whose mothers have
10 Philippines
Bangladesh Guatemala Vietnam Jordan
some education.15 Many other mothers have had some
India
El Salvador Bolivia schooling, but dropped out before they developed literacy
Egypt
0
Indonesia
skills. Worldwide, 776 million adults – about two-thirds of
0 10 20 30 40 50 60 70 80 90 100
them women – lack basic literacy skills.16 Illiteracy rates are
Female literacy rate (%)
highest in sub-Saharan Africa and South and West Asia,17 but
In countries where more mothers are literate, more children stay in this problem is not restricted to developing countries. Many
school. The correlation between maternal education and children’s economically advanced countries also record high levels
success in school is well documented. Children of better-educated
mothers tend to start school on time, progress through the grades of literacy problems. For example, 1 million native Dutch
at expected rates and are more likely to complete primary school. speakers in the Netherlands are classified as functionally
In Burkina Faso and Niger, roughly 4 in 5 women are illiterate and illiterate. In metropolitan France, some 10 percent of the
over half of all primary school-aged children are out of school.
Compare this to Argentina, Mongolia and Tajikistan, where nearly population aged 18 to 65 – more than 3 million people –
all women are literate and almost all children are enrolled in school. lacks basic reading, writing, math and other fundamental
Note: Trend line based on data for 87 School Success Index countries. Sources: skills, despite having attended French schools.18 And in
Out-of-school children (est. 2006): UNESCO. EFA Global Monitoring Report
2009; Female literacy rates (est. 2007 or most recent): UNESCO Institute for the United States, 30 million adults (14 percent) lack basic
Statistics (UIS). Data Centre.
literacy skills.19

The Power of Early
Childhood Development
to Change the World
Research from around the world consistently shows that

investing in quality early learning programs is one of the
most effective ways to improve children’s success in school,
to increase incomes and to reduce costs to society. In fact,
the gains tend to be the highest when investments target the
most disadvantaged groups. Early childhood development
programs are changing children’s lives and opening doors to
brighter futures for the world’s poorest children in settings
as diverse as the impoverished villages of Africa, the remote
hollers of Appalachia, and the slums of Europe’s cities.
Early childhood development programs come in many
forms. Efforts focused on pregnant women ensure mothers’
good health and encourage breastfeeding and bonding.
Home visiting and parent support networks show mothers
and other caregivers how to talk more, read more and have
more positive interactions with their young children. And
preschool activities augment the good work parents do at
home – or make up for support that may be lacking in the
home – to build children’s cognitive aptitudes, motivation
levels, self-control and sociability. These programs may be
funded nationally or locally, they may be public or private,
for-profit or nonprofit, or in partnership with multiple
sectors. They may be located in a well-equipped classroom
in Vietnam, or under a mango tree in Uganda, or at the
kitchen table of a home on a Navajo Indian reservation.
What matters is that these programs work. Numerous • ethiopia
studies show that gains made in early learning programs
carry over into the first years of school, well into adulthood, preschool, grade repetition rates were twice as high as in
and go on to benefit society as a whole. places where half the children had access to preschool (12
percent versus 25 percent) and dropout rates were 2.5
An early start toward success in school times higher (20 percent versus 50 percent). The benefits
Children who get a proper start in their earliest years are of ECD were greatest among children from the poorest
better learners when they get to school. They pay attention families with the least educated parents.21
better, they catch on faster, they are more engaged and • In Istanbul, Turkey, an early enrichment program
less shy, they interact better with their classmates and provided parenting education and preschool activities to
enjoy themselves more. Many studies have shown that ECD low-income, low-education families. After seven years,
programs help children succeed in school: 86 percent of the children who participated were still in
• In remote rural villages in Siraha, Nepal , more than school, compared to 67 percent of children who did not
95 percent of children who attended an early learning participate. Over the long run, participant children had
program went on to primary school, compared to higher school attainment and were more likely to attend
75 percent of non-participating children. The grade university.22
one repetition rate of participants was one-seventh • In North Carolina , low-income, African-American
that of non-participants, and the ECD children scored children who received high-quality early education from
significantly higher on grade one exams. Differences in infancy to age 5 did better in school in reading and math,
school starting rates were especially striking for girls and were more likely to stay in school longer, graduate from
disadvantaged dalit (untouchable caste) children.20 high school and attend a four-year college. They were
• A study of 24 countries in sub-Saharan Africa found also older, on average, when their first child was born.23
that increased preschool enrollment boosted primary
completion rates and lowered dropout and repetition
rates. In places where children had no access to
• nepal Save the children | 13

The Power of Early Childhood
Development to Change the World
eventually yield a “profit” to society. “A publicly financed,

The Earlier in Life the Investment, comprehensive ECD program for all children from low-
the Bigger the Payoff income families would cost billions of dollars annually, but
would create much larger budget savings over time,” said
Rates of return to human capital investment, ages 0 to adult Robert Lynch, an economist at Washington University. “By
about the 17-year mark, the net effect on budgets for all
Programs targeted towards the earliest years levels of government combined would turn positive. Within
25 years, by 2030 if a nationwide program had been started
Preschool programs in 2005, the budget benefits would exceed costs by $31
billion (in 2004 dollars). By 2050, the net budget savings
Schooling would reach $61 billion (in 2004 dollars).” 26
Job training Internationally, economists estimate that each extra
year of primary education will increase a person’s future
productivity by 10 to 30 percent, varying country to country.27
0-3 4-5 Studies from across the United States and around the
Preschool School Post schooling
world support these estimates:
Age • The seminal High/Scope Perry study in Ypsilanti,
Michigan , examined the lives of 123 African Americans
To be most effective, investments in early childhood care and born in poverty and at high risk of failing in school.
development should begin at birth, according to studies by Researchers began following the 3- and 4-year-olds in
Nobel Prize-winning economist James Heckman. For the most
at-risk children, kindergarten may be too late. 1962. Half the children received a high-quality preschool
Chart adapted from Heckman and Masterov: The Productivity Argument for program and half did not. By age 40, the preschool
Investing in Young Children. (October 2004). participants were more likely to have graduated from high
school, to have higher earnings, hold a job, own their own
homes, and commit fewer crimes than those who did not
Success in life and positive change for attend preschool.28
future generations
When more children do better in school and in life, all of
Preschool Can be a Foundation
society benefits. Investments in early learning programs are
for a Lifetime of Higher Achievement
a powerful tool to fight poverty, violence and numerous
other social ills. Money spent today on the nurturing of Major findings to age 40, High/Scope Perry Preschool Study
young children can eliminate the need for far greater
Program group No-program group
government spending in the future on remedial education,
early pregnancy, poverty assistance, prisons and wars. 67
Ready for school at 5
Research by Nobel Prize-winning economist James 28
Commited to school at 14 61
Heckman shows that the returns on investments in early 38
49
childhood are greater than investments at any other stage Basic achievement at 14
15
of life. Quality early learning programs – especially those High school graduate 77
60
aimed at disadvantaged children – “raise the quality for Earned $20K+ at 40 60
40
the workforce, enhance the productivity of school and 36
Arrested 5+ times by 40
reduce crime, teenage pregnancy and welfare dependency,” 55
said Heckman. “They raise earnings and promote social 0 20 40 60 80 100

Percent of group
attachment.” 24
Heckman and others have shown that a strong
investment in children’s development at the earliest stages By age 40, adults who participated as 3- and 4-year-olds in
can yield annual returns as high as 15 to 17 percent in better quality preschool were more likely to have graduated from high
school, to have higher earnings, hold a job and commit fewer
classroom performance, fewer health care costs, higher crimes than those who did not attend preschool.
workforce productivity, lower welfare costs and less crime.25 Source: Schweinhart, Xiang, Barnett,Belfield and Nores. Lifetime Effects:
In the United States, economists predict investments The High/Scope Perry Preschool Study Through Age 40. Monographs of the
High/Scope Educational Research Foundation, 14. (Ypsilanti, MI: High/Scope
in these programs will pay for themselves over time, and Press: 2005)

The added value of educating
young girls
The payoffs to society can be especially great when
countries invest in early learning initiatives that benefit girls.
When young girls participate in ECD programs, parents’
attitudes towards their daughters shift: they see their girls
as active individuals, capable of learning and directing their
own lives and futures. Once parents commit to preschool,
they typically enroll their daughters in primary school and
support them to continue. In addition, older girls – who
might be kept out of school to look after younger siblings
while their mothers and fathers work outside the home –
are freed by ECD programs to pursue their own education.
When girls go to school and stay in school longer, they
have a better chance to grow up healthy, well-nourished,
economically empowered and resourceful when it comes to
the health and education of their own children. 32 Educated
girls tend to marry later, have fewer children, healthier
• egypt pregnancies and safer deliveries. 33 Educated mothers
are better equipped to provide a positive early learning
• A program targeting unmarried, low-income, first-time environment for their young children in the home and to
mothers in Elmira, New York showed how home visits support their children’s educational progress when they go
can improve family safety and health. The women entered to school.34
the study prior to their 30th week of pregnancy and Research consistently shows that education for girls is
were visited at home by registered nurses, who provided one of the most effective investments a nation can make to
parent education, social support and referral to social improve the health and prosperity of future generations:
services. The program continued until children were • Educating girls helps prevent child deaths from
age 2. Compared to a control group, the mothers who malnutrition and disease. A study of the factors
received the home support had better diets, smoked contributing to child malnutrition in 63 developing
less, had 75 percent fewer preterm births and higher countries found that female education was by far the most
birthweight babies. A 15-year follow-up found fewer important reason why child malnutrition decreased by
incidents of child abuse, fewer subsequent pregnancies, 15.5 percent between 1970 and 1995.35 Educated mothers
less use of welfare and less criminal behavior among the are also much more likely to immunize their children.36
mothers who participated. The benefit-cost ratio of the • Educating girls has a catalytic effect on economic
program was estimated at $4 for every $1 invested, and development, including higher productivity and faster
the higher-risk the mother, the higher the return on economic growth. One cross-country analysis estimated
investment (up to $6.90 per dollar invested among the that each 1 percent increase in female education would
highest-risk mothers).29 increase a country’s average level of GDP by 0.37
• A preschool health program in Delhi, India increased percent. 37
average school participation by 7.7 percentage points for • Advancements in girls’ education played a key role in
girls and 3.2 percentage points for boys. With estimated catalyzing the “Asian Miracle” that brought economic
returns for each additional year of education for girls in prosperity to Indonesia, Malaysia, South Korea, Thailand
India at 5 percent and boys at 9 percent, the return in the and other countries during the past half-century. In the
labor market would be more than $14 per dollar spent. 30 1950s, these countries had education levels and literacy
• World Bank analyses in Colombia and Egypt found rates comparable to those in sub-Saharan Africa. Today,
benefit-cost ratios of 3 to 1. In Egypt, the benefits were roughly 93 percent38 of the adult population can read and
as high as 5.8 to 1 when the early childhood development write (compared to 62 percent in sub-Saharan Africa), 39
programs targeted children most at risk. 31 and the average gross national income per capita is 2 to
13 times higher than that of the average African country.40

School Success Index for
Developing Countries
Save the Children introduces a first-ever School Success Index school. South Asia also has large percentages of children
for Developing Countries comparing the status of the youngest not attending primary school. In Bhutan, 20 percent are out
children in 100 of the world’s poorest countries. We looked of school. In Nepal, 24 percent are out of school. And in
at the health, academic achievement and parental care of Pakistan, 34 percent of primary school-aged children are not
children under age 5 and ranked 100 countries based on how in school.
well their young children are prepared to succeed in school. Many of these out-of-school children started first grade
We found alarming numbers of young children in with their peers, but because they did not have good health,
developing countries are not even remotely ready for school. home support and preschool education in their early years,
These children’s early days, months and years are often they were not prepared to thrive in a school environment
spent fighting for survival, and many of their families are and dropped out in the early years of primary school. In fact,
too consumed with meeting basic needs to provide quality in many developing countries, 50 percent of dropouts occur
learning and socialization opportunities for their young in the first year of school.42
children at home.
Still, there are some bright spots – relatively poor Where are young children best
countries that are doing an admirable job of preparing their prepared to succeed in school?
youngest children to do well in school and in later life. These Cuba, Armenia, Cyprus, Chile and Azerbaijan are the top
successes point to greater investments that must be made five countries in the School Success Index. In these countries,
globally in order to lay a strong foundation for learning and almost all mothers are literate and the average woman bears
open the doors of education to millions of children. only one or two children, so the quality of home care for
This analysis is based on indicators of early childhood young children tends to be higher. The relatively high child
growth and development that together are highly predictive survival rates in these countries (ranging from 96 to nearly
of success in primary school (defined as entrance into the 100 percent) indicate that most families are able to provide
last grade of primary school, usually grade four or five). For nutritious meals for their children and that health systems
each country, we evaluated: do a good job of caring for pregnant women, new mothers,
• Under-5 survival rates – to measure the overall health babies and toddlers.
and nutritional status of children, as well as quality and In these five countries, most primary school-aged
availability of health care for mothers, infants, toddlers children are in school and they pass successfully from first
and young children. to second grade, then continue to do well throughout
• Grade one repetition rates – to evaluate whether primary school. In Armenia, however, 9 percent of primary
children are entering primary school with sufficient school-aged children are not in school. And in Azerbaijan, 14
cognitive skills, knowledge and social readiness to do well percent are not in school.
and learn. Automatic promotion from grade one to grade Countries in South Asia and sub-Saharan Africa dominate
two is the law in many developing countries, so grade one the lower end of the Index, due to higher poverty, poor
repetition and dropout rates grossly underestimate early health care and inadequate schools throughout both of these
school failure, but they are the best indicators we have. regions. But there are a few exceptions. Sri Lanka ranks 8th
• Female literacy rates – to gauge the likelihood on the Index – ahead of most other South Asian countries.
that young children benefit from a home environment Children in Sri Lanka are in relatively good health and 90
that encourages essential language and learning skill percent of women are literate. Only 3 percent of primary
development. Mothers’ education is also strongly school-aged children are out of school, less than 1 percent
correlated with children’s health. repeat first grade, and 93 percent of children in first grade
• Total fertility rates – which reflect the well- make it to fifth grade.43
documented link between smaller family size and In sub-Saharan Africa, Cape Verde, South Africa and
improved health, nutrition and education of children. Botswana outperform other countries in the region, though
We also compared the number of children who should their ranks – all in the 40s – are still disappointing. These
be in primary school in each country to the number who countries have relatively high female literacy rates (at or
actually are in school, and we found large numbers of above 80 percent), and grade one repetition rates are
children missing out on education entirely. In sub-Saharan relatively low. But while the percentages of children out of
Africa, for example, nearly a third of primary school-aged school are lower than most other countries in the region,
children are not in school.41 In Burkina Faso and Niger, more 9 to 16 percent of primary school-aged children in these
than 50 percent of primary school-aged children are not in countries are not in school, and trends suggest rates are
• mozambique Save the children | 17

Country or Territory Primary school-aged children Gross intake ratio School Under-5 Grade 1 Female Total
out of school in the last grade Success survival rate (%) repetition literacy rate (%) fertility rate (%)
of primary school Rank rate (%)
absolute no.
percentage (thousands)
2007 2006 2007 2007 2007 2007 2007
Cuba 1 27 93 1 99 Ø 100 1.5
Armenia 9 12 91 2 98 Ø 99 1.4
Cyprus 1 0.3 101 3 100 1 97 1.6
Chile – – 95 4 99 3 96 1.9
Azerbaijan 14 82 93 5 96 0.3 99 1.8
Brunei Darussalam 3 1 107 6 99 1 93 2.3
China – 655‡ – 7 98 1 90 1.7
Kazakhstan 1 9 101 8 97 0.1 99 2.3
Sri Lanka 3 51 106 8 98 1 90 1.9
Mongolia 2 7 110 10 96 1 98 1.9
Kuwait 11 24 91 11 99 3 92 2.2
Kyrgyzstan 8 29 95 12 96 0.2 99 2.5
Maldives 2 1 129 13 97 1 97 2.6
United Arab Emirates 2 13 105 13 99 3 89 2.3
Uzbekistan – 5‡ 100 15 96 Ø 96* 2.5
Bahrain 1 0.4 117 16 99 3 86 2.3
Qatar 2 1 104 16 99 1 90 2.7
Vietnam 6* – 102* 16 99 3 87* 2.2
Colombia 9 367 107 19 98 6 93 2.2
Eduador 1 11 106 20 98 3 92 2.6
Trinidad and Tobago 11 15 88 21 97 11 98 1.6
Argentina 1 36 97 22 98 10 98 2.3
Jamaica 9 31 82 23 97 4 91 2.5
Jordan 6 53 99 23 98 1 89 3.1
Turkey 9 729 96 23 98 4 81 2.1
Tunisia 3 27 120 26 98 1 69 1.9
Peru 1 33 101 27 98 5 86 2.5
Uruguay 2 0.1 99 27 99 14 98 2.1
Costa Rica – 41‡ 91 29 99 14 96 2.1
Indonesia 2 418 99 29 97 7 88 2.2
Iran, Islamic Republic of 6 391 105 29 97 4 79 2.0
Mexico 1 73 104 29 97 7 91 2.2
Oman 25 82 88 33 99 0.3 77 3.0
Venezuela, Bolivarian Rep. of 6 226 98 33 98 8 93* 2.6
Panama 1 4 99 35 98 9 93 2.6
Tajikistan 2 19 95 36 93 0.0 100 3.4
Philippines 8 953 94 37 97 6 94 3.3
Dominican Republic 15 255 89 38 96 6 90 2.8
Myanmar 1 16 95 39 90 1 86* 2.1
Cape Verde 15 9 86 40 97 2 79 3.4
Paraguay 5 43 95 40 97 10 93 3.1
South Africa 9 469 92 42 94 6 87 2.7
Bolivia 4 52 101 43 94 1 85 3.5
Botswana 16 49 95 44 96 7 83 2.9
Egypt 2 233 98 45 96 Ø 61 2.9
El Salvador 6 39 91 46 98 13 83 2.7
Occupied Palestinian Territory 23 94 83 47 97 0.0 89 5.2
Suriname 6 2 84 47 97 18 88 2.4
Syrian Arab Republic 3* 102‡ 114 49 98 12 76 3.1
Brazil 4 597 106 50 98 24 91 2.3

Country or Territory Primary school-aged children Gross intake ratio School Under-5 Grade 1 Female Total
out of school in the last grade Success survival rate (%) repetition literacy rate (%) fertility rate (%)
of primary school Rank rate (%)
absolute no.
percentage (thousands)
2007 2006 2007 2007 2007 2007 2007
Honduras 3 33 88 51 98 14 84 3.3
Algeria 4 88 95 52 96 12 66 2.4
Nicaragua 9 72 73 53 97 18 81 2.8
Belize 1 0.4 106 54 98 14 70* 3.0
India 6 7,208 86 55 93 4 54 2.8
Namibia 13 89 77 56 93 20 87 3.2
Bangladesh 8 1,371 72 57 94 7 48 2.9
Iraq 11 508 75 58 96 9 64* 4.3
Bhutan 20 20 73 59 92 8 42 2.2
Morocco 11 429 83 59 97 16 43 2.4
Swaziland 21 45 67 61 91 21 78* 3.5
Lesotho 27 102 78 62 92 28 90* 3.4
Pakistan 34 6,821 62 63 91 6 40 3.5
Sudan 56* 2,798‡ 50 63 89 3 52* 4.3
Cambodia 11 213 85 65 91 21 68 3.2
Guatemala 3 83 77 66 96 24 68 4.2
Ghana 28 967 71 67 89 10 58 3.9
Kenya 24 1,371 93 67 88 6 70* 5.0
Tanzania, United Rep. of 2 143 74 69 88 8 66 5.2
Madagascar 1 106 62 70 89 13 65* 4.8
Yemen 25 906 60 70 93 4 40 5.5
Lao People’s Dem. Rep. 16 125 75 72 93 33 67 3.2
Mauritania 19 92 59 72 88 9 48 4.4
Nepal 24 702 76 74 95 26 44 3.3
Senegal 27 513 49 75 89 5 32 4.7
Zambia 5 150 88 76 83 6 60* 5.2
Comoros 45* 36‡ 50 77 93 33 70 4.4
Congo 42 243 73 77 88 28 82 4.5
Nigeria 35 8,097 72 79 81 4 64 5.4
Benin 17 244 64 80 88 1 28 5.5
Gabon 11* 10‡ 75* 81 91 48* 82 3.1
Malawi 12 202 55 82 89 23 65 5.6
Mozambique 24 954 42 83 83 4 33 5.2
Ethiopia 28 3,721 46 84 88 7 23 5.3
Cameroon – 475‡ 55 85 85 26 60* 4.4
Côte d’Ivoire 44* 1,164‡ 45 85 87 20 39* 4.5
Uganda – 1,168‡ 54 87 87 18 66 6.5
Togo 21 176 57 88 90 24 38* 4.9
Guinea 25 389 64 89 85 4 18* 5.5
Rwanda 6 303 35 90 82 18 60* 5.9
Congo, Dem. Rep. of the – 5,203‡ 38* 91 84 18* 54* 6.7
Burkina Faso 52 1,215 33 92 81 6 22 6.0
Niger 56 1,245 33 93 82 0.2 16 7.2
Equatorial Guinea 11* 26‡ 58 94 79 35 80* 5.4
Central African Republic 46 375 24 95 83 31 33* 4.6
Mali 37 793 49 96 80 10 16 6.5
Guinea-Bissau 55* 132 ‡ 27* 97 80 24* 54 7.1
Burundi 25 324 36 98 82 37 52* 6.8
Afghanistan – 1,816‡ 38 99 74 9 13* 7.1
Chad 40* 1,186‡ 31 100 79 23 13* 6.2
For complete methodology, indicator Note: Data refer to the year specified in * In the absence of recent data, ‡ Data are UNICEF estimates: www.
definitions, data sources and discussion the column heading or the most recent estimates from the UNESCO Institute childinfo.org/education_outofschool.
of study limitations see Methodology and year available. for Statistics based on outdated census php
Research Notes. or survey information from 2003 or
earlier were used and should be – No data
interpreted with caution. Ø Magnitude nil or negligible

rising. Between 1999 and 2007, the number of out-of-school
children in South Africa rose from 1.4 to 8.6 percent. And in
Cape Verde, it climbed from 1 to 14.8 percent.44
Among East Asian countries, Brunei and China score
the highest (6th and 7th place), due mostly to their national
wealth. But Vietnam’s performance is perhaps more
noteworthy given its meager resources. Vietnam’s per capita
national income (PPP) is one-half that of China and nearly
one-twentieth that of Brunei,45 yet Vietnam’s performance
on school-readiness indicators is only a few points behind
the two wealthier countries. Most of Vietnam’s children
benefit from relatively good health and nutrition and
87 percent of females are literate. Ninety-four percent
of primary school-aged children are in school and less
than 3 percent repeat first grade. Ninety-two percent of
Vietnamese children in the first grade make it to the
fifth grade.46
Healthier Children Do Better

in School
Percentage of children who complete primary school
300 Under-5 mortality rate 120

Under-5 mortality rate (per 1,000 live births)
Percentage of children who complete • vietnam

primary school
250 100
Where do young children face the

200 80 greatest obstacles to success in school?
Chad, Afghanistan, Burundi, Guinea-Bissau and Mali are
150 60 the bottom five countries on the School Success Index. In
these countries, dire poverty, lack of public services and
100 40 conflict stack the odds against the youngest children. Large
percentages of females are illiterate (more than 80 percent in
50 20 Afghanistan, Chad and Mali), and the average woman bears six
or more children in her lifetime, so few children get the kind
0 0 of care, encouragement and stimulus they need at home in
their early years. Approximately 1 child in 5 in these countries
Afghanistan
Mozambique
Senegal
Yemen
Côte d’Ivoire
Ethiopia
Malawi
Pakistan
Bangladesh
Nepal
Guatemala
Morocco
El Salvador
Egypt
Jordan
Vietnam
Thailand
does not even survive to age 5, and those who do make it

often suffer from cognitive and physical impairments that limit
their development and productivity for the rest of their lives.
In countries where children under 5 have higher survival rates, In Burundi, 25 percent of primary school-aged children
children are likely to do better in school. Higher child survival rates are not attending school. In Mali, 37 percent are not in
indicate that, generally speaking, mothers and children are better
nourished and are receiving better health care. They also indicate school. In Chad, 40 percent are not in school. And in
that families are giving children the kind of care and interaction that Guinea-Bissau, 55 percent are not in school. Many of the
helps children thrive as well as survive. These factors contribute to children who do make it to school in these countries are not
improved cognitive and emotional development in young children.
Children with better health also miss fewer days of school due to doing well there. In Mali, 10 percent of students must repeat
sickness and find it easier to concentrate and learn. first grade. In Chad, it’s 23 percent. In Guinea-Bissau, it’s 24
Sources: Under-5 mortality rate: UNICEF. State of the World’s Children 2009; percent. And in Burundi, 37 percent of students repeat first
Gross intake ratio to last grade of primary school (proxy for completion):
UNESCO Institute for Statistics (UIS). grade. Burundi’s grade one repetition rate has been steadily
increasing since 2000, when it was 24 percent.47

In addition to Afghanistan, several other South Asian

Early Childhood During War countries are struggling to prepare their young children
and Conflict to do well in school. Bangladesh, Bhutan, India, Nepal and
Pakistan all score in the bottom half of the Index, due
The harsh circumstances of war can have an especially mostly to very low levels of female literacy and inadequate
disastrous and lasting impact on children. Basic nutrition and health care for children. Large percentages
protections break down and children are vulnerable (20 to 34 percent) of primary school-aged children in
to physical violence, separation from parents, sexual Bhutan, Nepal and Pakistan are not attending school at all.
and gender-based abuse, land mines, displacement and First grade repetition rates are in the 4 to 9 percent range,
recruitment into armed groups. with the exception of Nepal, where 26 percent of students
The most profound impact on young children must repeat first grade. In India and Bangladesh, less than
is often that their caregivers are unable to meet two-thirds of first graders make it to the fifth grade. 50 In
their needs for nurturing and support. Parents Afghanistan, only 38 percent of children make it into school
may be missing, wounded or dead. Or they may be and through to the last grade. 51
emotionally and physically exhausted and unable to South Asia has some of the highest rates of stunted
provide care and protection. Losing a parent is one growth in the world. In this region, a third to a half of
of the most traumatizing events a young child can all children under 5 are moderately to severely stunted
experience. And children who witness horrors such (stunting rates range from 36 percent in Bangladesh to 54
as killing, rape or the destruction of their home can percent in Afghanistan, which has the highest rate in the
suffer severe psychological damage. world). 52
Twenty of the bottom 31 countries in the School While countries in Latin America tend to score fairly high
Success Index are either currently experiencing on the Index, young children in several Central American
armed conflict, emerging from conflict or hosting countries are lagging way behind in school readiness. Belize,
large refugee populations from neighboring conflicts. Guatemala, Honduras and Nicaragua all score in the bottom
Afghanistan and Chad – the two bottom-most half of the Index. In Honduras and Belize, 14 percent of
countries in the ranking – have the lowest preschool children must repeat first grade. In Nicaragua, 18 percent
enrollment rates in the world.48 Other conflict- repeat first grade (this rate has doubled since 1999). 53 And
affected countries scoring very low on the Index in Guatemala, 24 percent repeat first grade.
include: Burundi, Guinea-Bissau, Mali, Central African These Central American countries also have the lowest
Republic and Democratic Republic of the Congo.49 school retention rates in the region. In Guatemala and
In recent years, a number of NGOs and Honduras, 1 in 3 children in first grade will not make it to
international organizations have come up with better fifth grade. 54 In Nicaragua, roughly 1 in 2 first graders does
ways to shield young children from the traumas of not make it to fifth grade. 55 High rates of female illiteracy in
war and to encourage healthy development, even in these countries contribute to children’s poor performance
very dangerous places (see page 39 for more about safe in school. In Honduras and Nicaragua, about 1 in 5 women
spaces in conflict zones). is illiterate (16 and 19 percent respectively). In Belize and
Guatemala, it’s nearly 1 in 3 (30 and 32 percent).
The picture in Central America is not altogether
discouraging. Several of these countries have made
considerable progress in getting children into school. In
Guatemala and Honduras, the percentages of children out
of school are only about a quarter what they were in 2000.
And between 1999 and 2006, Nicaragua more than halved
the percentage of children out of primary school – from 20
to 9 percent. 56
• DR congo

Where are the most children out of school?
Countries with the greatest number of primary school-aged children not in school
Greatest Number of Children Greatest Share of Children
Out-of-school children, Out-of-school children,

Rank Country 2007-2008* (thousands) Rank Country 2006-2008* (percentage)
1 Nigeria 8,097 1 Liberia 69%

2 India 7,208 2 Djibouti 62%
3 Pakistan 6,821 3 Niger 56%
4 DR Congo 5,203 3 Sudan 56%**
5 Ethiopia 3,721 5 Guinea-Bissau 55%**
6 Sudan 2,798 6 Eritrea 53%
7 Afghanistan 1,816 7 Burkina Faso 52%
8 United States 1,683 8 Central African Republic 46%
9 Bangladesh 1,371 9 Comoros 45%**
9 Kenya 1,371 10 Côte d’Ivoire 44%**
* Data refer to the most recent year available during the period specified. ** Data refer to years other than those specified.
Sources: Absolute number of out-of-school children: For Afghanistan, DR Congo and Sudan: UNICEF. www.childinfo.org/education_outofschool.php; All
other countries: UNESCO. EFA Global Monitoring Report 2009; Percentage of out-of-school children: UNESCO Institute for Statistics (UIS). Data Centre.
• india

Ethiopia •
AIDS and Early Childhood

Today, 33 million people in the world are living with illness, poor cognitive and social development, dropping
HIV, including 2 million children under 15 years of age. 57 out of school, homelessness, becoming involved in crime,
The overwhelming majority of these children were child labor, prostitution and exposure to HIV infection
born to mothers with HIV and about 90 percent live in later in life.60
sub-Saharan Africa. 58 With their survival, growth and When parents are ill, or are busy caring for someone
development threatened from the very beginning, most of who is HIV-positive, children – especially girls – may be
these children will live shortened lives, dying before they kept out of school to provide care for younger siblings
are in their teens. or other young children. When both parents have
Many millions more children are adversely affected died and other caregivers are not available, orphaned
by AIDS, because they have lost a parent or they live in children sometimes live in child-headed households. In
a community where much of the adult population is sick, Rwanda, for example, a reported 100,000 children are
dying or dead. An estimated 15 million children have lost living in child-headed households, due in large part to
one or both parents to AIDS. 59 Children under 5 are conflict and AIDS.61 Care-giving children lose their own
especially vulnerable, because so much of their survival childhood while the younger children for whom they care
and healthy development is dependent on the care they miss the adult interaction that is so critical for healthy
get from adults. development.
Witnessing a parent’s illness and death is traumatic For more about what can be done to help young children
for a young child. Children whose parents have HIV or overcome the extreme disadvantages associated with AIDS,
AIDS can also face stigma and discrimination. Children in see page 38.
AIDS-affected families are at higher risk of malnutrition,

School Success Index
for the United States
Save the Children introduces a first-ever United States School this to the bottom five states, where 30 to 44 percent of
Success Index comparing early childhood conditions across ninth graders do not graduate from high school within four
the country and showing where American children have the years with a regular diploma.63
best and worst chance to succeed in school. We ranked Educational advancement tends to continue through
all 50 states, plus the District of Columbia, based on how the college years. In Connecticut, Massachusetts, New
well their youngest children are faring in terms of parental Hampshire and Vermont, roughly half of all young adults
encouragement, preschool participation and quality of the aged 18 to 24 are enrolled in college or graduate school.64 In
home environment. Maine, the college enrollment rate is 43 percent.65
We found states where alarming numbers of children are Children in the top five states will grow up to earn
not getting the care and support they need in their early significantly higher incomes than most children in the
years, and as a result are at great risk of failure in school. bottom five. Median household income in Connecticut,
Even in the highest-ranked states, significant percentages of Massachusetts and New Hampshire, for example, is 70 to 80
young children are falling through the cracks. Clearly, greater percent higher than that of Mississippi, which has the lowest
investments in early childhood care and development are level of household income in the nation.66
needed everywhere. If you look at the flip side of the School Success Index
The analysis uses indicators that, taken together, are indicators for the top five states, however, it is clear that
strongly predictive of reading proficiency in the fourth grade. many families with young children in the Northeast could
We looked at how often parents read to their children, use extra help. In Massachusetts, for example, 15 percent of
how many children go to preschool, how many children children are not read to three days a week and 22 percent
are growing up in single-parent households, and how many of children have mothers whose emotional health could be
mothers are mentally and emotionally healthy. better. In all five states, about a quarter of children under
age 5 are growing up in single-parent households.
Where are young children best The top five states score among the highest in the nation
prepared to succeed in school? in fourth grade reading proficiency, but public school test
Connecticut, New Hampshire, Massachusetts, Vermont and results show there is great room for improvement in even
Maine scored highest on the School Success Index. In these the “best” of states. Massachusetts has the nation’s highest
states, generally speaking, parents and communities are fourth grade reading proficiency level – 49 percent read
doing a good job of preparing children to succeed in school. at or above grade level, but that means 51 percent do not.
Still, the findings point to pockets of need, even in the best- Connecticut, New Hampshire and Vermont all have 41
performing states. percent fourth grade reading proficiency (so 59 percent
In the top five states, at least 85 percent of young are not proficient). And in Maine, only 36 percent of fourth
children are read to frequently by a family member. In all graders are proficient in reading (64 percent are not).
but Maine, preschool enrollment rates are at or above
the national average and there are fewer single-parent Where do young children face
households than in most other states. About 80 percent of the greatest obstacles to success
children in these states have mothers who are reported to in school?
be in very good or excellent mental and emotional health. New Mexico, Nevada, Mississippi, Arizona and Alabama are
Families in Maine and Vermont lead the nation in reading the five lowest-ranked states in the School Success Index. In
to their young children. In both of these states, 89 percent these states, too many parents are struggling to give their
of children are read to three or more days per week. young children the encouragement, stimulus and attachment
Connecticut has the highest preschool enrollment rate of they need in their early years. And as a result, too many
any state (65 percent). Children in New Hampshire and children are starting school ill-prepared to learn.
Vermont have mothers with the highest reported levels of About a quarter of all children in these five states are not
mental and emotional health. And Massachusetts has the read to enough. In all but Mississippi, preschool enrollment
highest percentage of fourth graders testing at or above levels are far below the national average, ranging from 28
grade level in reading (49 percent). percent in Nevada to 43 percent in Alabama. Thirty to 43
Children in the top five states are more likely to go on percent of young children in these states live in single-parent
to do better in school and in life. Vermont, New Hampshire households. And about 30 percent of children under 5 have
and Connecticut have some of the lowest high school mothers whose mental and emotional health is less than
dropout rates in the nation (less than 4 percent).62 Compare optimal.
• Louisiana Save the children | 25

Families in Mississippi lag behind the rest of the country
when it comes to reading to their young children. Mississippi
is tied for last place with Georgia and Louisiana on this
indicator – in all three states only 73 percent of children
are read to three or more days per week. Mississippi also
has the highest percentage of children living in single-parent
households of any state (43 percent). Nevada has the
nation’s lowest preschool enrollment rate (28 percent). And
31 percent of children under 5 in Nevada and New Mexico
have mothers whose mental and emotional health could be a
good deal better.
Greater Needs for Young Children

in Rural Areas
A recent study found many of the lowest-ranked

states on the School Success Index have large unmet
educational needs in their rural areas.
The study looked at factors such as the size of the
rural population in each state, poverty, unemployment
and adult education levels in rural areas, educational
expenditures, and school performance of fourth and
eighth graders in these areas. It prioritized states
having the greatest educational needs in their rural
areas.
Six of the bottom ten states on the School Success
Index ranked among the top ten states with the most
urgent rural education needs. Mississippi, Alabama
and Arizona ranked first, second and third in terms
of rural education needs. Tennessee, New Mexico
and Louisiana ranked seventh, eighth and ninth. Texas
and California also have significant rural education • MISSISSIPPI
challenges, and ranked 13th and 26th respectively.67
Compared to their urban and suburban peers, After missing out on important learning and growth
young children in rural areas are more likely to live experiences in their early years, children in the bottom
in low-income families, to be overweight, to live in a states tend to do poorly in primary school. In Alabama, 71
household with a smoker, and to have unmet mental percent of fourth graders in the public schools are reading
health needs.68 Rural children are less likely to be below grade level. In Arizona, Nevada and New Mexico,
breastfed, and less likely to receive preventive health 76 percent read below grade level. And in Mississippi, 81
and dental care.69 And though there has been progress percent are not reading at grade level.
in recent years, rural children remain at higher risk for Poor performance in primary school is often a sad
inadequate prenatal care, low birthweight and infant prelude to difficulties later in life. Teen dropout rates
mortality.70 are high in Arizona, Alabama and Nevada, where 1 in 10
teenagers is a high school dropout.71 Rates are little better
in New Mexico and Mississippi, where 8 percent of 16- to
19-year-olds are dropouts.72
The bottom five states have some of the highest teen
birth rates in the nation. In Alabama, Arizona, New Mexico
and Mississippi, girls aged 15 to 19 are about five times as

the United States
likely as girls in Maine to become teen mothers.73 Girls in Children in Alabama and Nevada, for example, are roughly
Nevada are four times as likely as girls in Maine to become four times as likely as children in Vermont to become
teen mothers.74 In New Mexico and Mississippi, roughly 16 juvenile offenders.83
percent of all births are to women under the age of 20 – And in the bottom-ranked states, few young people go
more than any other state.75 Similarly, in Arizona, Nevada on to higher education. In Nevada, only 27 percent of young
and New Mexico, about 30 percent of births are to mothers adults aged 18 to 24 are enrolled in college or graduate
with less than a high school education. In Mississippi and school. College enrollment rates are similarly low in the
Alabama, 24 and 22 percent of births, respectively, are to other four bottom-ranked states. They range from 33
mothers without a high school diploma.76 percent in Arizona to 39 percent in Alabama.84
The bottom-ranked states tend to have higher A number of the bottom-ranked states struggle with
percentages of young people in trouble with the law. higher-than-average unemployment rates. In Alabama, for
example, the unemployment rate in 2007 was 30 percent
Poor Nutrition, Obesity and higher than in New Hampshire or Vermont (6.7 percent
Low School Achievement compared to 5.1 percent). And in Mississippi – where 9.3
percent of the population 16 years and older are without
work – unemployment rates are more than 80 percent
Low birthweight, poor nutrition, physical inactivity higher.85
and childhood obesity are all directly associated with And in the lowest ranked states, even those who find
lower levels of student achievement.77 gainful employment have lower earnings potential. Full-time,
Poor nutrition starts long before birth, and the year-round workers in each of the bottom five states earn at
eating and exercise patterns children establish in least $10,000 less a year than their peers in Connecticut and
their earliest years set the stage for lifelong habits. Massachusetts. Median earnings in Connecticut are nearly 60
In addition to impeding cognitive development, poor percent higher than median earnings in Mississippi ($50,325
nutrition also contributes to many health problems compared to $32,045).86
and sets children up for poor health throughout As a result of unemployment and low earnings, poverty
their lives – at a cost to them, their communities and rates among adults aged 18 to 64 tend to be highest in the
society.78 bottom five states. In Alabama, Arizona, Mississippi and New
For two decades, the incidence of low birthweight Mexico, poverty rates are well above the national average. In
in America has been on the rise.79 About 1 in 12 babies Alabama, New Mexico and Mississippi, 15, 16 and 18 percent
born in the United States is low birthweight. Black of adults live in poverty. These rates are more than double
babies are about twice as likely as white or Hispanic those found in Connecticut (7.1 percent) or New Hampshire
babies to have low birthweight.80 (6.6 percent).87
Childhood obesity is rapidly reaching epidemic
proportions in the United States. According to the
most recent studies, 9.5 percent of American children
under age 2 (birth to 23 months) are overweight.
Among infants and young children aged 6 months to
23 months, the obesity rate is 11.5 percent.81 And
by the time children reach the 2 to 5 age group, 23.3
percent – nearly a quarter – are overweight or obese.
This rate has quadrupled since the late 1970s, when
overweight prevalence was only 5 percent for 2- to
5-year-olds.82
arizona •

Early Learning Inequities in America
In the United States – like everywhere in the world

– it is the poorest, most marginalized children who
are most likely to enter school unprepared to learn.
The United States has one of the world’s widest gaps
between rich and poor, so the disparities are especially
striking.
Poor children in America are about twice as likely
as other American children to live in single-parent
families and unsafe neighborhoods, to have three or
more siblings (large family size), to experience harsh
discipline (spanked two or more times per week), to
be born to a teenage mother and/or a mother with
high levels of maternal depressive symptoms. They are
about three times as likely to have mothers who are
high school dropouts, to have fewer than 10 children’s
books in the home, 88 and to be chronically absent
from kindergarten.89 Compared to affluent children,
poor children are also much more likely to skip meals
and go hungry.90
Black and Hispanic children are much more likely
to experience hardships than white children. The
prevalence of single-parent families, low birthweight,
harsh parenting and maternal depressive symptoms
is highest among black children. Hispanic children are
the most likely to have mothers who did not complete
high school and to have few children’s books in their
homes.91
Few Hispanic Children Are Ready for School
80
Percentage of preschoolers whose parents
70
School
report school readiness skills
Count to 20 or higher
60 readiness gap
50
40
30 Recognize all letters
20
10 • arizona
0
Hispanic Black White Asian or Pacific
Islander
Hispanic parents report the lowest levels of school readiness skills in their
3- to 6-year-old children.
Data Source: O’Donnell, K. (2008). Parents’ Reports of the School Readiness of
Young Children from the National Household Education Surveys Program of 2007
(NCES 2008-051). National Center for Education Statistics, Institute of
Education Sciences, U.S. Department of Education. Washington, DC.

the United States
State 4th grade public school students School Children aged 0-5 Children aged 3-4 Children aged 0-5 Children aged 0-5
who scored below the proficient Success who are read to 3 or enrolled in nursery in single-parent whose mother's
level in reading Rank more days a week by school, preschool or households (%)*** mental and emotional
a family member (%) kindergarten** health status is
excellent or very
good (%)
percentage absolute no.
2007 2007 2003* 2007 2007 2003*
Connecticut 59 24,800 1 86 65 27 80
New Hampshire 59 8,900 2 87 47 23 81
Massachusetts 51 36,000 3 85 61 26 78
Vermont 59 3,900 4 89 49 29 81
Maine 64 9,100 5 89 41 27 80
Minnesota 63 37,400 6 87 43 25 80
Iowa 64 21,900 7 87 46 27 79
Maryland 64 39,100 8 84 49 30 81
New Jersey 57 55,900 9 77 64 26 77
Utah 66 26,800 9 82 39 17 78
Wyoming 64 3,900 11 86 44 32 80
Hawaii 74 10,200 12 82 52 27 76
Virginia 62 55,200 13 81 49 28 79
Idaho 65 13,000 14 82 33 20 79
Nebraska 65 13,300 14 84 43 28 79
Pennsylvania 60 77,500 14 86 48 30 77
Colorado 64 36,900 17 82 44 25 77
Washington 64 48,200 18 83 41 27 79
Montana 61 6,300 19 84 35 24 79
Kansas 64 21,200 20 84 45 28 76
Illinois 68 104,100 21 81 54 30 75
Missouri 68 45,200 22 83 43 32 79
New York 64 122,900 22 79 58 31 76
Michigan 68 81,200 24 81 46 31 78
Wisconsin 64 38,200 25 83 43 29 77
Florida 66 131,800 26 76 52 34 80
Kentucky 67 31,900 27 83 43 33 76
West Virginia 72 14,400 27 85 41 31 74
Oregon 72 29,900 29 83 39 26 74
Alaska 71 6,800 30 82 40 29 76
North Dakota 65 4,500 31 80 30 28 80
Delaware 66 5,900 32 84 45 36 75
North Carolina 71 77,100 33 81 45 33 75
South Dakota 66 5,900 34 82 38 33 77
Ohio 64 83,600 35 82 45 33 74
Indiana 67 52,400 36 81 39 31 74
Rhode Island 69 7,700 37 82 44 33 72
Oklahoma 73 33,200 38 81 41 34 74
South Carolina 74 37,800 39 82 49 38 71
Arkansas 71 25,400 40 75 47 35 75
Georgia 72 86,900 41 73 50 34 74
District of Columbia 86 3,900 42 74 68 47 74
Texas 70 239,600 43 75 42 31 72
California 77 362,800 44 76 50 29 66
Louisiana 80 41,100 45 73 52 42 75
Tennessee 73 52,500 46 76 38 36 74
Alabama 71 40,300 47 76 43 37 74
Arizona 76 61,600 48 74 36 32 71
Mississippi 81 30,000 49 73 51 43 71
Nevada 76 24,700 50 75 28 30 69
New Mexico 76 18,500 51 77 38 40 69
U.S. National 68 2,451,300 79 47 31 74
Notes:
* Findings from 2007 were not available primarily provide custodial care. For complete methodology, indicator Research’s (NIEER) quality benchmarks.
for inclusion in this report. For 2007 definitions, data sources and discussion For a review of access to, quality in and
data see www.nschdata.org *** Single-parent families may include of study limitations see Methodology and resources devoted to state-funded pre-
cohabiting couples and do not include Research Notes. school programs see: Barnett, Steven
**Includes children enrolled in educa- children living with step-parents or in et al. The State of Preschool 2008: State
tional programs sponsored by federal, group quarters (e.g. institutions, •State prekindergarten programs Preschool Yearbook. (NIEER).
state or local agencies, e.g. Head Start. dormitories, or group homes). are insufficiently funded to meet The
Does not include private homes that National Institute for Early Education

Early Childhood
Development Report Card
How do the more developed countries measure up on out of 10 minimum child care standards). Austria, Belgium,
early childhood development? We looked at ten minimum Germany, Hungary, Italy, Japan, Korea, Netherlands, New
child care standards in 25 countries to evaluate how well Zealand, Portugal, Slovenia and the United Kingdom all score
governments are ensuring children’s earliest experiences are higher than the United States. Each of these countries meets
in the best interest of both the children and their nations’ between 4 and 6 of the minimum child care standards.
future.
These ten benchmarks were drawn up in consultation with
government officials and academic experts from high-income
countries in Asia, Europe and North America, with input from
UNICEF and the World Bank.92 The benchmarks are:
• Parental leave of at least a year for one parent upon
the birth of a child, at 50 percent salary
• A national plan with priority for disadvantaged
children, indicating governments have at least drawn
up a plan for the organization and financing of early
childhood services
• Subsidized and regulated child care services for at
least 25 percent of children under 3
• Subsidized and accredited early education
services for at least 80 percent of 4-year-olds for
a minimum of 15 hours per week
• Minimum level of training for all child care staff –
at least 80 percent have some relevant training in
child care • mexico
• Minimum proportion of child care staff with
higher level education and training – at least The most widely met child care standard among wealthy
50 percent of staff in early education centers have countries is higher-level education of staff in early learning
a minimum of three years tertiary education with centers. Twenty of the 25 countries meet this standard,
recognized qualification in early childhood studies or a with 50 percent or more of staff in accredited early learning
related field centers having at least three years of specialized training.
• Minimum staff-to-child ratio – the ratio of preschool The standards addressing parental leave and public
children to trained staff is not greater than 15 to 1 and funding are met by the fewest countries – only 6 out of 25
group size does not exceed 24 countries guarantee a new parent leave of up to one year
• Minimum public funding – public spending on early at 50 percent of salary, and likewise only 6 countries spend
childhood education and care for children 0-6 is not less 1 percent or more of their GDP on early childhood
than 1 percent of GDP education and care.
• Low level of child poverty – a child poverty rate of Here are some additional facts about early child care
less than 10 percent and educational achievement in the economically advanced
• Universal outreach – an estimate of the extent to countries of the Organisation for Economic Co-operation
which basic child health services have been made available and Development (OECD):
to the most marginalized and difficult-to-reach families. • All but two countries – Australia and the United States
Sweden is the only country to achieve a perfect 10 out of 10 – currently provide an entitlement to some form of paid
on this Report Card. Iceland follows closely behind, meeting leave to employed parents following the birth of a child.93
9 of the 10 child care benchmarks. Denmark, Finland, France • In the United States and the United Kingdom, a majority
and Norway each meet 8 of 10 minimum standards. of children under age 1 are now in some form of child
Canada and Ireland are tied for last place, each having care for a substantial portion of each working day. In
achieved only 1 of the 10 child care benchmarks. Australia is United States, more than 50 percent of under-ones are
second from the bottom, meeting only 2 of 10 benchmarks. in some form of child care. Some 75 percent of these
The United States is in a tie for the third lowest ranking children begin going to child care at 4 months or earlier
with Mexico, Spain and Switzerland (each country meets 3 and for an average of 28 hours per week.94
• sweden Save the children | 31

Early Childhood
Development Report Card
• In the United States, public funds provided for pre- achievement on the most recent international assessment
kindergarten education come mostly from state and local conducted in 2006. At the same time, the United States
governments and amount to about 0.4 percent of GDP.95 ranked high in inequity, with the third largest gap in
Total public expenditure on child care and preschool science scores between students from different socio-
education services in the United States totals about 0.6 economic groups.96
percent of GDP, or roughly one-third of what is spent in • The United States is rapidly losing its historic edge in
Iceland. educational attainment. Four decades ago, America had
• The United States is falling behind other countries in the the best high school graduation rate in the world, but
resource that matters most in the new global economy: by 2006 it had slipped to 18th out of 24 industrialized
human capital. Among 30 OECD countries, American countries. As recently as 1995, the U.S. was still tied
15-year-olds ranked 25th in math and 21st in science for first place in the proportion of young adults with a
college degree, but by 2000 it had slipped to 9th and by
2006 to 14th – below the OECD average for the first
time.97 According to the latest OECD figures, the United
States has one of the highest college dropout rates in the
industrialized world – 53 percent of Americans who enter
college do not finish.98 Only Italy has a higher college
dropout rate (55 percent).
• The OECD estimates that each additional year of
schooling among the adult population raises a nation’s
economic output by 3 to 6 percent.99 A recent study
predicted that if the United States could improve its math
and science achievement levels over the next two decades
to become a top-performing nation on international
assessments, its GDP would be 5 percent higher by 2037
and 36 percent higher by 2080.100
• Countries such as Canada, Finland, Japan and Korea
have demonstrated that students from disadvantaged
backgrounds need not automatically perform poorly in
school. Demographers now predict that in the United
States, “minorities” will constitute the majority of
schoolchildren by 2023 and of working-age Americans
by 2039. The educational performance of American
minorities is far below the averages of most industrialized
nations. In 2006, Hispanic 15-year-olds in the U.S.
performed below the average of every OECD country
except Turkey and Mexico in science literacy. Black
students performed even worse.101
• Korea has gone from well behind to significantly ahead
of the United States in high school attainment in just
a few generations. According to the World Bank, “the
contribution of knowledge … was a key factor in Korea’s
miracle of rapid economic growth.”102 In 1960, Mexico’s
economic productivity was twice as large as Korea’s, but
by 2003 Korea’s GDP was twice as large as Mexico’s.103
• United States

Early CHILDHOOD Development Report Card*
How wealthy countries measure up on suggested minimum standards for ECD
Number of Parental A national Subsidized Subsidized 80% of 50% of Minimum 1% of Child Near- Percentage
bench- leave of plan with and and all child staff in staff-to- GDP spent poverty universal of children
marks 1 year at priority regulated accredited care staff accred- children on early rate less outreach aged 3-4
achieved 50% of for disad- child care early trained ited early ratio of childhood than 10% of essential enrolled in
2008 salary vantaged services education education 1:15 in services child health preschool‡
children for 25% of services services preschool services 2006
children for 80% tertiary education
under 3 of 4-year- educated
olds with
relevant
qualifica-
tions
Best in Class
Sweden 10 ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ 84
Iceland 9 ★ ★ ★ ★ ★ ★ ★ ★ ★ 94
Denmark 8 ★ ★ ★ ★ ★ ★ ★ ★ 94
Finland 8 ★ ★ ★ ★ ★ ★ ★ ★ 44
France 8 ★ ★ ★ ★ ★ ★ ★ ★ 112
Norway 8 ★ ★ ★ ★ ★ ★ ★ ★ 89
"A" for (Average) Effort

Belgium (Flanders) 6 ★ ★ ★ ★ ★ ★ 125
Hungary 6 ★ ★ ★ ★ ★ ★ 82
New Zealand 6 ★ ★ ★ ★ ★ ★ 91
Slovenia 6 ★ ★ ★ ★ ★ ★ 75
Austria 5 ★ ★ ★ ★ ★ 68
Netherlands 5 ★ ★ ★ ★ ★ 37
United Kingdom** 5 ★ ★ ★ ★ ★ 90
Germany 4 ★ ★ ★ ★ 97
Italy 4 ★ ★ ★ ★ 105
Japan 4 ★ ★ ★ ★ 83
Portugal 4 ★ ★ ★ ★ 72
Republic of Korea 4 ★ ★ ★ ★ 24
Falling Behind
Mexico 3 ★ ★ ★ 53
Spain 3 ★ ★ ★ 123
Switzerland 3 ★ ★ ★ 26
United States 3 ★ ★ ★ 48
Australia 2 ★ ★ 42
Canada 1 ★ —
Ireland 1 ★ 24
Total benchmarks met 6 19 13 15 17 20 12 6 10 8
* Report Card adapted from UNICEF: The Child Care Transition, ★ Benchmark met
Innocenti Report Card 8. (Innocenti Research Center: Florence: 2008)
— Data not available
** Data for the United Kingdom refer to England only
‡ Source: OECD (2008), Education at a Glance 2008, Table C2.1

Keeping Young
Children Healthy,
Safe and Learning
Although the particulars of their lives may differ, millions

of parents around the world – in poor countries and rich “I Didn’t Do This With My
countries – face the same challenges: finding the time, Other Children”
the energy and the resources to provide for their young
children. All mothers and fathers want their children to grow Delfia is a 32-year-old mother of five living in a small
up strong and healthy, protected from harm, excited about farming community in western El Salvador. She does
learning and confident in their abilities. They search for not know how to read or write, and there are no
guidance from informal support networks and community schools in her village. But Delfia has found a way to
organizations as they struggle, often against great odds, to give her youngest child, 18-month-old Juan, a good
give their children a better future. start on his education.
Early childhood care and development programs support A community health promoter visited Delfia at
families so they can give their infants and toddlers a better home a few months ago and gave her a set of colorful
start. These programs typically do not cost a lot, and the laminated cards. The cards suggest fun learning
cognitive and emotional growth they promote in the early activities Delfia can do with Juan to help him develop
years of life result in tangible economic returns down language, cognition, emotional and motor skills. “I use
the road. What’s more – the damage done to children by the cards to play with my son,” she says. “We put the
inadequate attention in early childhood cannot be easily or toys inside the bucket, then outside, like it shows on
inexpensively reversed. the cards.” Using the cards, Delfia also sings with Juan
To ensure that investments in the youngest children are and asks him to reach for things, name things, count
made in ways that do the most good, Save the Children things and identify different body parts. Juan doesn’t
has developed the following recommendations. Based on always know the answers to Delfia’s questions, but he
decades of experience, these practices have succeeded enjoys trying, and he is developing important language
in a wide range of countries to encourage the healthy skills.
growth and development of young children. These solutions The health promoter also encourages families in
empower parents and caregivers to do what’s best for their Delfia’s village to go for prenatal visits and well-baby
children. And they encourage young children to develop visits where children receive vaccines. When she sees
the inquisitiveness, determination, creative thinking and the health promoter, Delfia often asks for new cards.
perseverance they need to succeed in school and in life. “These cards help children learn more,” she says.
“I didn’t do this with my other children, but with Juan
Building the foundation I do, and I know it’s going to help him.”
for lifelong learning The laminated cards are provided through
Even in “ordinary” circumstances, it can be tough to Save the Children’s Early Steps to School Success
be a parent. Feeding, protecting, teaching, guiding and program, in cooperation with El Salvador’s Ministry
encouraging young children to be the best they can be of Health.
requires a lot of time and energy. Few parents today – in
the developing world or the industrialized world – live
in settings where a village or extended family raises the
children. Many women must work for their families’ survival,
and as caregivers to their young children are tired, stressed,
and very short on time. The poorer a family is, the harder
it is to provide basic nutrition, health care, stimulation
and interaction children need for healthy growth and
development.
Here are some key investments that will help parents and
communities give the best possible futures to their youngest
children:
Health care – Good care for newborn babies must
begin with care for pregnant mothers, ensuring that they are
adequately nourished, free from infections and exposure to
harmful substances, and monitored for complications during
• afghanistan Save the children | 35

The Difference Preschool Can Make
pregnancy. Every year, around 50 million mothers in the

developing world give birth at home with no professional
care whatsoever.104 Pregnant women and newborn babies
are especially vulnerable to infections and complications
that – if they do not kill them – can injure or weaken them
for life. Good prenatal and postnatal care includes counseling
to encourage a safe birth, awareness of danger signs that Anita, age 4, is the first child you are likely to notice
require immediate attention, a plan for going to a skilled when you visit the early childhood development
health care provider, counseling on newborn care practices, center in Simalphanta village in far-western Nepal. She
and help to ensure immediate and exclusive breastfeeding. is very enthusiastic and is usually the first to call out
The quality and availability of health care for mothers and answers to the teacher’s questions. Ten years ago,
children varies greatly from country to country, but it is safe chances are that Anita would have been among the 70
to say the majority of children under age 5 in the poorest percent of dalit (untouchable caste) children in this
regions of the world do not get basic health care when they part of Nepal who did not complete primary school.
need it.105 Health outreach strategies and funding must do Today, she is looking toward a brighter future.
a better job of targeting the poorest and most marginalized Anita’s mother, Manju, age 26, says Anita loves to
mothers and children in every country. More funding is go to school. “Whenever I try to keep her at home to
needed for wellness, prevention and family planning, as help me with chores, she insists on going to school,”
well as for staffing, transport, equipment, medicine, health says Manju. “And she cries whenever there is no
worker training and the day-to-day costs of operating health school.” Anita’s teacher, Madhavi, talks about how
systems. Good curative care for young children should start attentive Anita is in class and how she likes to write
in the home, where many of the simplest ailments can be and dance. When she comes home from school, Anita
successfully and inexpensively treated by informed parents, often shows her parents the dances she learned that
supported by community-based health outreach workers. day.
Nutrition – The links between good nutrition and Anita’s parents are both illiterate and her two
healthy brain development have been well documented. older siblings – ages 10 and 8 – are behind in school.
Yet it is estimated that 30 percent of children under age 5 Her 10-year-old sister is in second grade and her
in developing countries (169 million children) do not get 8-year-old brother is in first grade. Neither of the
enough of the right food to eat or do not benefit from what older children attended ECD classes. Asked about the
they eat because of parasitic infections and other forms of difference between Anita and her older siblings, Manju
diarrheal disease.106 These undernourished children have replies: “Anita asks me to comb her hair, oil her hair
lowered resistance to common childhood ailments like and cut her nails. She tells me not to eat food touched
respiratory infections. Frequent illnesses sap the nutritional by flies, or else I will get sick. My older children never
status of children who survive, locking them into a vicious did these things. I am learning from Anita to be more
cycle of recurring sickness and faltering mental and physical hygienic around the house.”
growth. Childhood malnutrition is most common in the Anita’s teacher says she has high hopes for Anita.
developing world, but poor families in wealthy countries also “Anita likes to try everything,” said Madhavi. “She is
struggle to feed their children an adequate and healthy diet. very good at role playing and she likes to play doctor.
Poverty and food scarcity are complex problems, but She always wants to be the doctor and have another
a number of low-cost solutions can make a difference child be the sick person. She diagnoses tummy aches
for young children. Breastfeeding works everywhere to and tells the other children their problem is that they
protect children against developmental delays and improve did not eat good food. So maybe she will become a
language and motor skill development. And Vitamin A doctor.”
supplementation has saved and improved the lives of millions Save the Children began its early childhood
of children in the developing world.107 development program in Nepal in 1997. We
When children get plenty of one-on-one interaction currently support more than 1,000 centers like
and cognitive stimulation along with improved feeding, it is the one in Simalphanta with teacher training,
a win-win strategy that yields better nutrition outcomes educational materials and funds for preschool building
in the near term and improved adult capacities in the long construction.
term. The recipe for early feeding is straightforward yet too

Inspiring a Love of Learning at Home
Keeping Young Children

Healthy, Safe and Learning
seldom followed: breastfeed exclusively for 6 months, then

add good complementary foods. Recent studies suggest that
young children who have stimulating learning experiences
along with improved nutrition develop better than those Jordan is 2 years old and his favorite books are
who have improved nutrition alone.108 These compounded Goodnight Moon (which he has memorized) and
benefits can lead to improved lifetime productivity and The Hungry Caterpillar (which he likes because of
economic gains for entire nations if they are achieved at the colors, especially the rainbow at the end).
scale.109 Jordan lives in a remote community on the Navajo
Coaching and classes for new parents – Parents Nation in northern Arizona. His parents’ small
are the most influential people in a young child’s life, and two-room house is more than 20 miles from the
when they are equipped with better child-raising tools and nearest grocery store, hospital and school. There is
techniques they can often do wonders. Many successful no plumbing in the house, but it’s nice and cozy, with
programs in developing and industrialized countries have plenty of books, and interesting activities that Jordan’s
improved outcomes for children by teaching new moms and parents have learned will help him develop his language
dads to be better parents. This can be done through home- skills and social abilities, so he’ll be ready for school
based coaching, community support groups and classes for when the time comes.
new parents. In addition to breastfeeding and basic health As part of Save the Children’s Early Steps program,
care, these programs encourage parents to feed their Jordan and his parents receive a visit twice a month
children safer and more nutritious food, to interact more from a child development specialist named Karen who
with their children, to create a learning environment in the brings books, activities, guidance and information
home, and to discipline without hitting. Parenting coaches can about how children grow and learn. Karen urges
also serve as a critical first line of defense against child abuse Jordan’s parents to read to him as much as possible,
and neglect, intervening on the child’s behalf when necessary and to talk with him using regular language, not baby
and rallying community resources to safeguard the child. talk or jibber jabber. She has explained about how a
Better early child care providers and preschool child’s brain develops and how they are role models
teachers – Good child care is an extension of good for their son. Jordan’s parents are now teaching him
parenting. The quality of early childhood education colors, shapes and numbers, using ordinary items
outside the home depends on the ability of the caregiver around the house.
to provide a secure, consistent, sensitive, stimulating and Jordan’s parents are delighted at his progress.
rewarding environment. To be successful, early child care Already, Jordan is using language that is advanced for
and preschool facilities – whether center, community or his age, and he is correcting his parents when they
home based – should have sufficient numbers of staff for get things wrong. Jordan’s father says he is very proud
the number of children, and the caregivers should be well of Jordan, and every day he cannot wait to see what
trained, well supervised and well paid. In addition, every Jordan will say or do next. Just yesterday, he opened
effort should be made to retain caregivers so that they are the door by himself for the first time.
consistent, familiar and reassuring figures in children’s lives.
In many countries, child care professionals are at the
bottom of the wage ladder and have little in the way of believe children benefit most from full-time parental care for
either job security or opportunity for career advancement. the first year of life, while others believe it is fine for children
Preschool and kindergarten teachers are excluded from to begin out-of-home care after three months, provided that
many teachers’ unions and civil service pay scales and care is of good quality. But whatever parents believe may be
benefits. Women dominate the professions that teach best for their children, the very real need to earn a living is
and care for very young children. Their lack of status and often the deciding factor when it comes to child care. Only
inadequate pay diminish the quality of professional care- a handful of high-income countries provide parental leave for
giving. The quality of family life and mothering that caregivers the first year after a child is born with at least 50 percent
can give their own children is also affected, since many must salary (see pages 31-33). In the developing world, parental
take on additional work to earn enough income to survive. leave benefits are less generous if they exist at all.
Parental leave and child care assistance – Around Services for special needs children – “Special needs”
the world, few parents have the advantage of paid time off is an umbrella term for a wide array of difficulties that may
from work to care for their youngest children. Some experts impede a child’s normal growth and development. Children

with special needs may have mild learning disabilities or
Preschools Help Fight the Ravages profound mental retardation; food allergies or terminal
of AIDS illness; mild emotional issues or serious psychiatric
problems. Though the term is broad, it is still useful in
helping to get needed services to the child, for setting
appropriate goals, and for gaining understanding for a child
and a stressed family. Parents and out-of-home caregivers
often need guidance on how best to help a child with special
needs.
Keeping children safe

Conflict, AIDS, displacement, migration. Children today are
growing up with challenges that are daunting and threaten
the development of an entire generation. Even though they
may not understand the meaning of what they see and
Children in Mozambique’s Gaza Province live in some hear, children absorb the images that surround them and
of the most disadvantaged communities in the world. are deeply impacted by the emotions of the people they
The area has been hit hard by HIV and many of the rely on for love and security. During difficult and uncertain
children are orphans, having lost one or both parents times, parents and caregivers need to help children cope
to AIDS. High poverty levels, compounded by the and recover from stressful experiences. But oftentimes,
overwhelming number of adult deaths, have left many these adults need help themselves, especially when they are
young children without the care they need to develop emotionally and physically drained by violence in the home, a
to their full potential. Many 3- to 5-year-olds already natural disaster, civil unrest or conflict.
show signs of delayed cognitive and behavioral Children who have experienced trauma may suffer from
development. disrupted sleep, increased alertness, bed-wetting, profound
One year ago, thousands of orphans and vulnerable sadness, frequent worry, obsessive-compulsive behaviors,
children in 42 communities in southern Gaza got a withdrawal, regression and/or increased aggression. Parents
chance to go to preschool and start turning their lives often need guidance to understand better what their infants
around. A new Save the Children initiative, funded and young children are going through. Some parents are
by donations from American Idol viewers, opened 96 frightened themselves and need support and confidence-
preschools offering children a safe place to play, learn building in order to settle down and learn how to
and prepare themselves to do well in school. understand their children’s behavior, listen to their children,
The preschools have well-trained teachers who sooth and reassure their children, and help them heal.
are sensitive to the special needs of children affected Very young children may not need specialized therapy to
by HIV and AIDS. The teachers ask the children recover from trauma. They benefit from a return to routine,
questions, laugh with them and encourage the children opportunities to play and to let their imaginations help
to share their ideas and be heard. Many children who them come to terms with past events. Relief organizations
had become withdrawn or aggressive after losing a are increasingly establishing “safe spaces” in disaster and
loved one have started to open up again. war zones for just this purpose. These are special places
“Many children here drop out in first grade where children can feel secure again while they enjoy toys,
because they are not prepared for school,” said games and music, and establish positive relationships with
Damião Mungoi, education program coordinator for sympathetic and supportive adults. For these children, the
Save the Children in Mozambique. “These children live greatest benefits may come when they return to a healthy,
in rural and remote villages where they speak dozens safe and supportive community.
of local languages. When entering first grade, they are
overwhelmed and confused because they don’t know Gender roles and parenting
Portuguese, the national language used in schools. But in today’s global world
now, by attending preschool, these children will be In less than a century, families, households and gender roles
ready for first grade.” have been transformed as markets have become global.
Many women raise children alone without other adults

Keeping Young Children Healthy,
Safe and Learning
to share in the joys and challenges of parenting. In the

developing world, as in industrialized nations, parental leave A Place to Learn, Safe from Conflict
and benefits in the formal work sector vary, from social
security systems with good benefits, to businesses with on-
site child care, to incentive zones where worker protections
are relaxed to attract investment.
In most developing countries, the majority of working
mothers are in agriculture or nonformal markets. For them,
every hour away from work is income or productivity
lost. Most solve their child care dilemma by reaching
out to friends and family for help looking after their
children. Voluntary and community-based organizations
may lend some assistance, but support to informal child
care arrangements and networks needs to be much more In Karamoja, Uganda, one of the driest and poorest
systematic, of better quality, and more available particularly regions of Africa, families compete fiercely for
to the poor who need it most. Many women need help and water and pasture land to raise cattle for market.
assistance to think through, plan and implement quality care In recent years, feuds and violence over cattle have
and a stimulating learning environment for multiple children become so commonplace that some children consider
in settings that may be crowded and even unsafe. cattle raiding a natural part of growing up. It is not
The value of mothering is critical for nothing less than uncommon for children to awake at night and find
the future of humankind. Economic data show clearly that their small village in flames, as cattle are stolen from
investing in child care and development pays off over the their family and neighbors. The next morning they will
long term. Tools and resources exist to make all child care be filled with fear and anxiety.
quality care – to keep all children healthy, safe and learning – But now children between the ages of 2 and 5 in
even in a global world of “new” gender roles. What appears one village in Karamoja have a special preschool center
to be missing is political will. they can attend where adult caregivers help them cope
with their feelings. Children like going to the center,
first of all, because they get food there. “If we stay
at home, there is nothing to eat,” says one boy. “At
the center we get porridge.” They also enjoy listening
to stories, singing songs, playing games and doing art
activities that they cannot do at home.
When children arrive at the center agitated by the
violence, the caregivers have been trained to respond.
“They sit the children down, talk with them, and
explain what’s being done to make things better,” says
Rosemary Akech, Save the Children’s regional director
in Karamoja. “Then they make sure the troubled kids
are mixed in with other children who haven’t gone
through trauma, so it calms them down.”
Children at the preschool also get regular health
check-ups including immunizations, Vitamin A
supplements, deworming treatments and growth
monitoring.
The center is adjacent to the elementary school,
and Rosemary likes to see the preschool students
show an interest in continuing their education. “They
point to the primary school and tell me, ‘After the
center, I want to go to that school.’”
• vietnam

Take Action Now for
the World’s Youngest
Children!
Worldwide, 75 million children fail to complete primary Go to www.savethechildren.org/advocacy to send a note

school, either because they drop out in the early grades or of support to your member of Congress.
because they never got the chance to attend school at all. In • Join the Save the Children Action Network to
the United States, nearly 2.5 million – or 68 percent – of all receive monthly email updates on legislative issues
American fourth graders are not reading at grade level. regarding education as well as other critical policy issues
Research has shown that early childhood development affecting children. Learn about ways that you can get
is an especially powerful lever to move the world towards involved and make your voice heard. To sign up visit:
a better future. By ensuring that young children have the www.savethechildren.org/advocacy.
care and encouragement they need to succeed in school, • Support on-the-ground programs that work. Visit
communities vastly improve their ability to fight poverty, www.savethechildren.org to learn more and do more!
prevent illiteracy, end hunger, reduce child mortality,
improve maternal health, combat disease and ensure
education for all. Education for all
Children in the United States and overseas deserve
a strong start in life. Help us build a better future for all Save the Children supports the Education for All global
children: movement to provide quality basic education for all
• Contact your government leaders and tell them children. The countries of the world have recognized
you support early childhood development around the vital role that education plays in growing
the world. Urge them to allocate funds for early economies, fighting poverty, and promoting health and
childhood learning programs in developing countries and security for future generations. World leaders have
to create plans of action to expand ECD programs and agreed to the broad goal of “education for all” by the
improve ECD policies. If you are a United States citizen, year 2015. The first of six key Education for All goals is
urge your congressional representatives to fund $1 billion to expand early childhood care and education.
for basic education in developing countries – including
support for early childhood development – and $900
million for child survival programs to provide critical
health care to children under 5. Go to
www.savethechildren.org/advocacy to send a note
of support to your member of Congress.
• Urge your congressional representatives to
support early childhood development in the
United States. Ask your member of Congress to
support a considerable increase in funding for Early Head
Start in fiscal year 2010, and to double funding for the
Child Care Development Block Grant (CCDBG), which
is the primary source of federal child care funding
for low-income working families. Also support local
and state initiatives that strengthen programs
for the development of young children.
malawi •
• armenia Save the children | 41

Appendix:
The Mothers’ Index and
Country Rankings
The tenth annual Mothers’ Index helps document conditions The 10 bottom-ranked countries in this year’s Mothers’ Index
for mothers and children in 158 countries – 43 developed are a reverse image of the top 10, performing poorly on
nations110 and 115 in the developing world – and shows all indicators. Conditions for mothers and their children in
where mothers fare best and where they face the greatest these countries are devastating.
hardships. All countries for which sufficient data are available • More than half (54 percent) of all births are not attended
are included in the Index. by skilled health personnel.
Why should Save the Children be so concerned with • On average, 1 in 24 mothers will die over the course of
mothers? Because more than 75 years of field experience her lifetime from pregnancy-related causes.
has taught us that the quality of children’s lives depends • 1 child in 7 dies before his or her fifth birthday.
on the health, security and well-being of their mothers. • 1 child in 3 children suffers from malnutrition.
In short, providing mothers with access to education, • Roughly 1 child in 4 is not enrolled in primary school.
economic opportunities and maternal and child health care • Only 4 girls are enrolled in primary school for every 5
gives mothers and their children the best chance to survive boys.
and thrive. • On average, females have only about 4 years of formal
The Index relies on information published by education.
governments, research institutions and international • Women earn less than half what men do for equal work.
agencies. The Complete Mothers’ Index, based on a composite • 9 out of 10 women are likely to suffer the loss of a child
of separate indices for women’s and children’s well-being, in their lifetime.
appears in the fold-out table in this appendix. A full The contrast between the top-ranked country, Sweden, and
description of the research methodology and individual the lowest-ranked country, Niger, is striking. Skilled health
indicators appears after the fold-out. personnel are present at virtually every birth in Sweden,
while only 33 percent of births are attended in Niger.
Mothers’ Index Rankings A typical Swedish woman has nearly 17 years of formal
European countries – along with New Zealand and Australia education and will live to be 83 years old, 65 percent are
– dominate the top positions while countries in sub-Saharan using some modern method of contraception, and only one
Africa dominate the lowest tier. The United States places in 185 will lose a child before his or her fifth birthday. At the
27th again this year. opposite end of the spectrum, in Niger, a typical woman has
While most industrialized countries cluster tightly at little over 3 years of education and will live to be 56. Only
the top of the Index – with the majority of these countries 5 percent of women are using modern contraception, and 1
performing well on all indicators – the highest ranking child in 6 dies before his or her fifth birthday. At this rate,
countries attain very high scores for mothers’ and children’s every mother in Niger is likely to suffer the loss of a child.
health, educational and economic status. The data collected for the Mothers’ Index document the
tremendous gaps between rich and poor countries and the
2009 Mothers’ Index Rankings urgent need to accelerate progress in the health and well-
being of mothers and their children. The data also highlight
Top 10 Bottom 10
Best places to be a mother Worst places to be a mother the regional dimension of this tragedy. Three of the bottom
Rank Country Rank Country
10 countries are Arab States and the remaining seven are in
sub-Saharan Africa. Sub-Saharan Africa also accounts for 16
1 Sweden 149 Djibouti
of the 20 lowest-ranking countries.
2 Norway 150 Eritrea
Individual country comparisons are especially startling
3 Australia 151 Angola when one considers the human suffering behind the
4 Iceland 152 Sudan statistics:
5 Denmark 153 Yemen • Fewer than 15 percent of births are attended by skilled
6 New Zealand 154 DR Congo health personnel in Chad and Afghanistan. In Ethiopia,
7 Finland 155 Guinea-Bissau only 6 percent of births are attended. Compare that to
8 Ireland 156 Chad 99 percent in Sri Lanka and 94 percent in Botswana.
9 Germany 157 Sierra Leone • 1 woman in 7 dies in pregnancy or childbirth in Niger. The
risk is 1 in 8 in Afghanistan and Sierra Leone. In Bosnia and
10 Netherlands 158 Niger
Herzegovina, Greece and Italy the risk of maternal death is
less than 1 in 25,000 and in Ireland it’s 1 in 47,600.
• vietnam Save the children | 43

Appendix: The Mothers’ Index and
Country Rankings
• A typical woman will die before the age of 45 in

Afghanistan, Angola, Mozambique, Sierra Leone, Zambia What the Numbers Don’t Tell You
and Zimbabwe. Life expectancy for women is only 42 in
Lesotho. In Swaziland, the average woman will not live to The national-level data presented in the Mothers’ Index
see her 40th birthday, while in Japan women on average provide an overview of many countries. However,
live to be more than 86 years old. it is important to remember that the condition of
• In Somalia, only 1 percent of women use modern geographic or ethnic sub-groups in a country may
contraception. Family planning rates are less than 5 vary greatly from the national average. Remote rural
percent in Angola, Chad, Democratic Republic of the areas tend to have fewer services and more dire
Congo, Guinea-Bissau and Sierra Leone. Eighty-two statistics. War, violence and lawlessness also do great
percent of women in the United Kingdom and 90 harm to the well-being of mothers and children,
percent of women in China use some form of modern and often affect certain segments of the population
contraception. disproportionately. These details are hidden when
• In Egypt, Morocco, Oman, Qatar, Sudan and the United only broad national-level data are available.
Arab Emirates, women earn 25 cents or less for every
dollar men earn. Saudi Arabian and Palestinian women
earn only 17 and 12 cents respectively to the male dollar. Australia and New Zealand, the average woman stays in
In Kenya, Mozambique and Sweden, women earn more school for more than 20 years.
than 80 cents for every dollar men earn. • Forty-five percent of children in Papua New Guinea
• In Micronesia, Qatar, Saudi Arabia and the Solomon are not enrolled in primary school. Rates are 49 and 56
Islands, not one seat in parliament is occupied by a percent in Niger and Djibouti. In comparison, nearly all
woman. In Papua New Guinea, women have only 1 of children in Australia, Belgium, France, Italy and Spain
109 seats. In Yemen, it’s 1 out of 301 seats in the lower make it from preschool all the way to high school.
house. Compare that to Rwanda, where well over • In Central African Republic, Niger and Yemen fewer than
half – 56 percent – of all seats in the lower house are 3 girls for every 4 boys are in primary school. In Chad and
held by women. In Sweden, women hold 47 percent of Guinea-Bissau, it’s about 2 girls for every 3 boys, and in
parliamentary seats. Afghanistan it’s even less – only 3 girls for every 5 boys
• A typical female in Afghanistan, Burkina Faso, Chad, DR are enrolled in primary school.
Congo, Eritrea and Guinea-Bissau receives less than • 1 child in 5 does not reach his or her fifth birthday in
5 years of formal education. In Angola, Djibouti and Chad and Equatorial Guinea. In Afghanistan and Sierra
Niger, women receive less than 4 years of education. In Leone, mortality rates are 1 in 4. In Iceland, Luxembourg,
Singapore and Sweden, only 1 child in 333 dies before age 5.
• Over 40 percent of children under age 5 suffer from
malnutrition in Bangladesh, India, Madagascar, Nepal,
Niger, Sudan and Yemen. In Timor-Leste, nearly half of
all children in this age group are moderately or severely
underweight.
• More than half of the population of Chad, DR Congo,
Ethiopia, Equatorial Guinea, Fiji, Madagascar, Mozambique,
Niger, Nigeria and Papua New Guinea lack access to safe
drinking water. In Somalia and Afghanistan, 71 and 78
percent of the population lack access to safe water.
Statistics are far more than numbers. It is the human despair
and lost opportunities behind these numbers that call for
changes to ensure that mothers everywhere have the basic
tools they need to break the cycle of poverty and improve
the quality of life for themselves, their children, and for
generations to come.
• Sierra Leone

Frequently Asked Questions about the Mothers’ Index
Why doesn’t the United States do better in the rankings? compared to 47 percent in Sweden and 42 percent in
The United States ranked 27th this year based on several Finland.
factors:
• One of the key indicators used to calculate well-being Why is Sweden number one?
for mothers is lifetime risk of maternal mortality. Sweden performed as well as, or better than, other
The United States’ rate for maternal mortality is 1 in countries in the rankings on all indicators. It has the
4,800 – one of the highest in the developed world. highest ratio of female-to-male earned income, the
Thirty-five out of 43 countries performed better than highest percentage of women with seats in the national
the United States on this indicator, including all the government and – along with Iceland and Luxembourg –
Western, Northern and Southern European countries the lowest under-5 mortality rate in the world.
(save Estonia and Albania) as well as Australia,
Bulgaria, Canada, Czech Republic, Hungary, Japan, Why are some countries not included in the Mothers’ Index?
New Zealand, Poland, Slovakia, and Ukraine. A woman Rankings were based on a country's performance with
in the United States is more than 5 times as likely as respect to a defined set of indicators related primarily
a woman in Bosnia and Herzegovina, Greece or Italy to health, nutrition, education, economic and political
to die from pregnancy-related causes and her risk of status. There were 158 countries for which published
maternal death is nearly 10-fold that of a woman in information regarding performance on these indicators
Ireland. existed. All 158 were included in the study. The only basis
• Similarly, the United States did not do as well as many for excluding countries was insufficient or unavailable
other countries with regard to under-5 mortality. data or national populations below 250,000.
The U.S. under-5 mortality rate is 8 per 1,000 live
births. This is on par with rates in Serbia, Slovakia What should be done to bridge the divide between countries
and Lithuania. Twenty-nine countries performed that meet the needs of their mothers and those that don’t?
better than the U.S. on this indicator. At this rate, a • Governments and international agencies need to
child in the U.S. is more than twice as likely as a child increase funding to improve education levels for
in Iceland or Sweden to die before his or her fifth women and girls, provide access to maternal and
birthday. child health care and advance women’s economic
• Only 61 percent of children in the United States are opportunities.
enrolled in preschool – making it the seventh lowest • The international community also needs to improve
country in the developed world on this indicator. current research and conduct new studies that focus
• The United States has the least generous maternity specifically on mothers’ and children’s well-being.
leave policy – both in terms of duration and • In the United States and other industrialized nations,
percentage of wages paid – of any wealthy nation. governments and communities need to work
• The United States is also lagging behind with regard to together to improve education and health care for
the political status of women. Only 17 percent of seats disadvantaged mothers and children.
in the House of Representatives are held by women,

2009 MOTHERS’ INDEX RANKINGS
Mothers’ Women’s Children’s Mothers’ Women’s Children’s
Index Index Index Index Index Index
Country Rank* Rank** Rank‡ Country Rank* Rank** Rank‡
TIER I: More Developed Countries TIER II: Less Developed Countries (continued)
SWEDEN 1 2 1 BOTSWANA 37 31 43
NORWAY 2 3 11 PARAGUAY 38 28 50
AUSTRALIA 3 1 27 EL SALVADOR 39 33 54
ICELAND 4 5 6 LIBYAN ARAB JAMAHIRIYA 39 36 46
DENMARK 5 6 19 UNITED ARAB EMIRATES 41 52 19
NEW ZEALAND 6 3 30 PHILIPPINES 42 32 59
FINLAND 7 7 21 QATAR 43 56 6
IRELAND 8 8 20 AZERBAIJAN 44 41 56
GERMANY 9 12 3 BELIZE 44 49 31
NETHERLANDS 10 9 26 BOLIVIA 44 44 50
FRANCE 11 13 4 HONDURAS 44 45 53
SPAIN 11 13 10 JORDAN 44 56 15
UNITED KINGDOM 13 10 21 GEORGIA 49 58 8
SWITZERLAND 14 16 17 IRAN, ISLAMIC REPUBLIC OF 49 45 45
SLOVENIA 15 13 17 LEBANON 49 55 18
ITALY 16 24 2 ALGERIA 52 53 41
BELGIUM 17 22 13 NAMIBIA 53 45 65
PORTUGAL 18 18 15 SRI LANKA 54 51 63
ESTONIA 19 23 13 TAJIKISTAN 55 50 67
CANADA 20 11 33 NICARAGUA 56 60 58
GREECE 21 21 16 TURKEY 57 63 23
LITHUANIA 22 17 28 GABON 58 41 72
CZECH REPUBLIC 23 27 11 INDONESIA 58 54 66
LATVIA 24 18 25 SYRIAN ARAB REPUBLIC 58 62 55
AUSTRIA 25 31 5 EGYPT 61 67 22
HUNGARY 26 25 23 KENYA 62 48 75
UNITED STATES 27 18 34 ZIMBABWE 63 61 68
LUXEMBOURG 28 34 9 GHANA 64 59 70
CROATIA 29 26 35 MOROCCO 65 71 57
MALTA 29 33 7 GUATEMALA 66 69 61
POLAND 31 29 28 OMAN 67 66 61
BELARUS 32 28 32 CONGO 68 65 71
SLOVAKIA 32 30 24 SWAZILAND 68 71 69
JAPAN 34 36 8 INDIA 70 73 73
BULGARIA 35 34 31 CAMEROON 71 70 76
ROMANIA 36 32 38 PAKISTAN 72 74 74
RUSSIAN FEDERATION 37 37 37 PAPUA NEW GUINEA 73 68 79
SERBIA 38 42 36 CÔTE D’IVOIRE 74 76 77
UKRAINE 39 39 39 NIGERIA 75 75 78
BOSNIA AND HERZEGOVINA 40 37 42
MOLDOVA, REPUBLIC OF 41 40 40
TIER III: Least Developed Countries
MACEDONIA,TFYR 42 41 43 MALDIVES 1 1 3
ALBANIA 43 43 41 CAPE VERDE 2 4 1
UGANDA 3 3 11
TIER II: Less Developed Countries RWANDA 4 5 17
CUBA 1 2 10 MALAWI 5 6 9
ISRAEL 2 1 2 CAMBODIA 6 2 21
ARGENTINA 3 4 12 LESOTHO 6 9 4
BARBADOS 4 3 5 BHUTAN 8 10 2
CYPRUS 5 6 1 SOLOMON ISLANDS 9 12 5
URUGUAY 6 5 2 MOZAMBIQUE 10 7 29
KOREA, REPUBLIC OF 7 8 6 NEPAL 11 13 11
KAZAKHSTAN 8 7 16 MADAGASCAR 12 8 31
COSTA RICA 9 11 11 TANZANIA, UNITED REPUBLIC OF 13 14 14
BAHAMAS 10 10 9 BURUNDI 14 11 25
THAILAND 11 9 16 SENEGAL 15 22 7
PANAMA 12 12 35 COMOROS 16 19 6
PERU 13 14 30 GAMBIA 17 21 8
CHINA 14 13 39 LAO PEOPLE’S DEMOCRATIC REPUBLIC 17 15 24
CHILE 15 20 2 MAURITANIA 19 17 21
BRAZIL 16 14 23 BANGLADESH 20 18 13
KYRGYZSTAN 17 17 32 TIMOR-LESTE 21 16 27
COLOMBIA 18 16 34 GUINEA 22 20 21
ECUADOR 19 21 37 LIBERIA 23 27 19
MEXICO 20 27 25 ZAMBIA 24 28 17
BAHRAIN 21 25 14 TOGO 25 29 16
UZBEKISTAN 22 22 32 ETHIOPIA 26 23 34
JAMAICA 23 24 28 EQUATORIAL GUINEA 27 24 32
VIETNAM 23 19 48 BENIN 28 31 15
MAURITIUS 25 28 26 BURKINA FASO 29 26 36
VENEZUELA, BOLIVARIAN REPUBLIC OF 25 25 35 MALI 30 25 37
KUWAIT 27 23 27 DJIBOUTI 31 34 20
DOMINICAN REPUBLIC 28 30 29 ERITREA 32 32 29
MONGOLIA 29 17 50 ANGOLA 33 30 39
TUNISIA 30 38 20 SUDAN 34 39 26
SOUTH AFRICA 31 33 44 YEMEN 35 39 28
ARMENIA 32 40 12 CONGO, DEMOCRATIC REPUBLIC OF THE 36 35 38
GUYANA 33 33 49 GUINEA-BISSAU 37 38 34
SURINAME 33 37 42 CHAD 38 33 41
TRINIDAD AND TOBAGO 33 38 37 SIERRA LEONE 39 36 40
MALAYSIA 36 43 20 NIGER 40 37 42
*** Due to different indicator weights and rounding, it is possible for a country to rank high on the women’s or children’s index but not score among the very highest countries in the overall
Mothers’ Index. For a complete explanation of the indicator weighting, please see the Methodology and Research Notes.
*** Rankings for Tiers I, II and III are out of the 43, 76 and 40 countries respectively for which sufficient data existed to calculate the Women’s Index.
‡ Rankings for Tiers I, II and III are out of the 43, 79 and 43 countries respectively for which sufficient data existed to calculate the Children’s Index.
46 | STATE OF THE WORLD’S MOTHERS 2009

The Complete Mothers’ Index 2009
TIER I Women’s Index Children’s Index Rankings TIER II Women’s Index Children’s Index Rankings
Development Group Health Status Educational Economic Status Development Group Health Status Educational Economic Political
Political Status Children’s Status SOWM 2009 Status Children’s Status SOWM 2009
Status Status Status
Lifetime risk Expected Ratio of Participation Lifetime risk Expected Participation Percent of
of maternal number of estimated of women Under-5 Gross Gross of maternal Percent of number of Ratio of of women Under-5 children under Gross Gross
MORE DEVELOPED LESS DEVELOPED
mortality Percent of Female life years of female in national mortality pre-primary secondary Mothers’ Women’s Children’s mortality births Percent of Female life years of estimated in national mortality 5 moderately primary secondary Percent of Mothers’ Women’s Children’s
COUNTRIES COUNTRIES and
(1 in women using expectancy formal to male government rate enrollment enrollment Index Rank Index Rank Index Rank (1 in attended by women using expectancy formal female to government rate or severely enrollment enrollment population Index Rank Index Rank Index Rank
TERRITORIES
number modern at birth schooling Maternity leave benefits earned (% seats held (per 1,000 ratio ratio (out of 43 (out of 43 (out of 43 number skilled health modern at birth schooling male earned (% seats held (per 1,000 underweight ratio ratio with access (out of 75 (out of 76 (out of 79
(minus least
stated) contraception (years) for females (2008) income by women) live births) (% of total) (% of total) countries)+ countries)+ countries)+ stated) personnel contraception (years) for females income by women) live births) for age (% of total) (% of total) to safe water countries)+ countries)+ countries)+
developed countries)
2005 2007 2008 2007 length % wages 2006 2009 2007 2007 2007 2005 2007 2007 2008 2007 2006 2009 2007 2007 2007 2007 2006
paid
Albania 490 8 80 11 365 days 1
80, 50 (a) 0.55 7 15 49 77 43 43 41 Algeria 220 95 52 74 13 0.35 8 37 4 110 83 85 52 53 41
Australia 13,300 64 84 21 52 weeks — (b) 0.73 27 6 104 150 3 1 27 Argentina 530 99 –– 79 16 0.56 40 16 4 112 84 96 3 4 12
Austria 21,500 47 83 16 16* weeks 100 0.40 28 4 90 102 25 31 5 Armenia 980 98 20 75 12 0.55 8 24 4 98 90 98 32 40 12
Belarus 4,800 42 75 15 126 days 100 0.64 32 13 103 95 32 28 32 Azerbaijan 670 88 12 71 11 0.66 11 39 10 98 83 78 44 41 56
Belgium 7,800 74 (q) 82 16 15 weeks 82, 75 (c) 0.52 35 5 121 110 17 22 13 Bahamas 2,700 99 60 77 12 (z) 0.72 12 13 –– 98 91 97 (y) 10 10 9
Bosnia and Herzegovina 29,000 16 78 11 (z) 1 year 100 0.67 12 14 10 85 40 37 42 Bahrain 1,300 98 31(s) 78 16 0.43 3 10 9 120 102 –– 21 25 14
Bulgaria 7,400 26 77 14 135 days 90 0.66 22 12 82 105 35 34 31 Barbados 4,400 100 53 80 16 0.64 10 12 6 (y) 105 103 100 4 3 5
Canada 11,000 73 83 17 17-18 weeks 55 (d,e) 0.65 22 6 68 117 20 11 33 Belize 560 96 53 79 13 0.40 0 25 6 123 79 91 (y) 44 49 31
Croatia 10,500 –– 79 14 1+ year 100 (f,g) 0.69 21 6 50 91 29 26 35 Bolivia 89 67 35 68 11 (z) 0.58 17 57 8 109 82 86 44 44 50
Czech Republic 18,100 63 80 15 28* weeks 69 0.60 16 4 114 96 23 27 11 Botswana 130 94 42 50 12 0.67 11 40 13 107 76 96 37 31 43
Denmark 17,800 72 81 17 52 weeks 100 (d) 0.74 38 4 95 120 5 6 19 Brazil 370 88 70 76 15 0.56 9 22 5 137 105 91 16 14 23
Estonia 2,900 56 77 17 140* days1 100 0.63 21 6 93 100 19 23 13 Brunei Darussalam 2,900 99 –– 80 14 0.42 –– 9 –– 106 97 –– — — —
Finland 8,500 75 83 18 105* days 11
70 0.72 42 4 62 112 7 7 21 Cameroon 24 63 13 51 8 0.50 14 148 19 110 25 70 71 70 76
France 6,900 77 84 17 16* weeks 100 (d) 0.62 18 4 116 114 11 13 4 Chile 3,200 100 58 82 14 0.41 15 9 1 104 91 95 15 20 2
Germany 19,200 66 82 16 (z) 14* weeks 100 0.61 32 4 106 102 9 12 3 China 1,300 98 90 75 11 0.65 21 22 7 111 76 88 14 13 39
Greece 25,900 34 82 17 119 days 100 0.53 15 4 69 103 21 21 16 Colombia 290 96 68 77 13 0.62 8 20 7 116 85 93 18 16 34
Hungary 13,300 68 78 16 24* weeks 70 0.67 11 7 86 96 26 25 23 Congo 22 83 13 57 8 0.50 7 125 14 106 43 71 68 65 71
Iceland 12,700 –– 83 19 3 months 80 0.73 33 3 96 110 4 5 6 Costa Rica 1,400 99 71 81 12 0.56 37 11 5 110 87 98 9 11 11
Ireland 47,600 –– 81 18 18 weeks 70 0.58 13 4 — 112 8 8 20 Côte d’Ivoire 27 57 7 49 5 (z) 0.32 9 127 20 72 25 81 74 76 77
Italy 26,600 39 84 17 5 months 80 0.49 21 4 104 100 16 24 2 Cuba 1,400 100 72 81 19 0.45 43 7 4 102 93 91 1 2 10
Japan 11,600 44 86 15 14 weeks 60 0.46 9 4 86 101 34 36 8 Cyprus 6,400 100 (y) –– 82 14 0.60 14 5 –– 102 97 100 5 6 1
Latvia 8,500 39 78 17 112 days 1
100 0.67 20 9 89 99 24 18 25 Dominican Republic 230 98 66 76 13 0.44 20 38 5 107 79 95 28 30 29
Lithuania 7,800 31 78 17 126* days1 100 0.72 18 8 69 99 22 17 28 Ecuador 170 99 58 78 11 (z) 0.57 28 (iii) 22 9 117 68 95 19 21 37
Luxembourg 5,000 –– 82 14 16 weeks 100 0.55 23 3 88 96 28 34 9 Egypt 230 74 57 74 10 (z) 0.25 2 36 6 105 88 98 61 67 22
Macedonia, the former Yugoslav Republic of 6,500 10 77 12 9 months — (h) 0.49 28 17 33 84 42 41 43 El Salvador 190 92 61 75 12 0.50 19 24 10 118 65 84 39 33 54
Malta 8,300 –– 81 15 14 weeks 100 (j) 0.53 9 5 97 99 29 33 7 Fiji 160 99 –– 71 13 0.49 –– 18 8 (y) 94 82 47 — — 64
Moldova, Republic of 3,700 44 73 12 126 days 1
100 0.63 22 18 70 83 41 40 40 Gabon 53 86 12 57 13 (z) 0.58 17 91 12 152 55 87 58 41 72
Montenegro 4,500 ‡ — 77 — –– –– 0.54 11 10 — — — — — Georgia 1,100 98 27 75 13 0.33 6 30 2 99 90 99 49 58 8
Netherlands 10,200 76 82 16 16 weeks 100 (d) 0.66 41 5 90 118 10 9 26 Ghana 45 50 19 61 9 0.71 8 115 18 98 49 80 64 59 70
New Zealand 5,900 71 82 20 14 weeks 100 (d) 0.72 34 6 92 120 6 3 30 Guatemala 71 41 34 74 10 0.33 12 39 23 113 56 96 66 69 61
Norway 7,700 69 83 18 42-52* weeks 80, 100 (k) 0.79 36 4 90 113 2 3 11 Guyana 90 83 34 70 13 0.47 30 60 12 115 105 93 33 33 49
Poland 10,600 19 80 16 16* weeks 100 0.60 20 7 57 100 31 29 28 Honduras 93 67 56 74 12 0.46 23 24 11 117 61 84 44 45 53
Portugal 6,400 63 81 16 120 days 100 0.61 28 4 79 97 18 18 15 India 70 47 49 67 9 0.32 9 72 46 112 55 89 70 73 73
Romania 3,200 38 76 14 126 days 85 0.70 11 15 72 86 36 32 38 Indonesia 97 72 57 73 11 0.46 12 31 28 114 66 80 58 54 66
Russian Federation 2,700 47 73 14 140 days1 100 0.63 14 15 87 84 37 37 37 Iran, Islamic Republic of 300 97 56 73 13 0.41 3 33 11 121 73 94 (y) 49 45 45
Serbia 4,500 ‡ 19 76 11 (z) 365 days 100 (l) 0.56 22 8 59 88 38 42 36 Iraq 72 89 33 62 8 –– 26 44 8 99 45 77 — — 60
Slovakia 13,800 41 79 15 28* weeks 55 0.59 19 8 93 96 32 30 24 Israel 7,800 99(y) 52(t) 83 16 0.67 18 5 –– 110 92 100 2 1 2
Slovenia 14,200 59 82 17 105 days 100 0.62 13 4 81 95 15 13 17 Jamaica 240 97 66 75 12 0.57 13 31 4 95 87 93 23 24 28
Spain 16,400 66 84 17 16* weeks 100 0.53 36 4 121 119 11 13 10 Jordan 450 99 41 75 13 0.31 6 24 4 97 89 98 44 56 15
Sweden 17,400 65 83 17 480 days 80 (m,d) 0.84 47 3 95 103 1 2 1 Kazakhstan 360 100 53 73 16 0.68 16 32 4 105 93 96 8 7 16
Switzerland 13,800 78 84 15 14 weeks 80 (d) 0.66 29 5 99 93 14 16 17 Kenya 39 42 32 55 9 0.82 10 121 20 106 50 57 62 48 75
Ukraine 5,200 38 74 15 126 days 100 0.58 8 24 94 94 39 39 39 Korea, Democratic People’s Republic of 140 97 58 69 –– –– 20 55 23 –– –– 100 — — —
United Kingdom 8,200 82 (r) 82 17 52 weeks 90 (n) 0.70 20 6 72 98 13 10 21 Korea, Republic of 6,100 100 67 82 15 0.52 14 5 –– 105 98 92 (y) 7 8 6
United States 4,800 68 81 16 12 weeks — (p) 0.64 17 (iv) 8 61 94 27 18 34 Kuwait 9,600 98 39(s) 80 13 0.40 3 (vi) 11 10 96 89 –– 27 23 27
To copy this table onto 8 1⁄2 x 11" paper, set your photocopier reduction to 85%
TIER I Women’s Index Children’s Index Rankings TIER II Women’s Index Children’s Index Rankings
Development Group Health Status Educational Economic Status Development Group Health Status Educational Economic Political
Political Status Children’s Status SOWM 2009 Status Children’s Status SOWM 2009
Status Status Status
Lifetime risk Expected Ratio of Participation Lifetime risk Expected Participation Percent of
of maternal number of estimated of women Under-5 Gross Gross of maternal Percent of number of Ratio of of women Under-5 children under Gross Gross
MORE DEVELOPED LESS DEVELOPED
mortality Percent of Female life years of female in national mortality pre-primary secondary Mothers’ Women’s Children’s mortality births Percent of Female life years of estimated in national mortality 5 moderately primary secondary Percent of Mothers’ Women’s Children’s
COUNTRIES COUNTRIES and
(1 in women using expectancy formal to male government rate enrollment enrollment Index Rank Index Rank Index Rank (1 in attended by women using expectancy formal female to government rate or severely enrollment enrollment population Index Rank Index Rank Index Rank
TERRITORIES
number modern at birth schooling Maternity leave benefits earned (% seats held (per 1,000 ratio ratio (out of 43 (out of 43 (out of 43 number skilled health modern at birth schooling male earned (% seats held (per 1,000 underweight ratio ratio with access (out of 75 (out of 76 (out of 79
(minus least
stated) contraception (years) for females (2008) income by women) live births) (% of total) (% of total) countries)+ countries)+ countries)+ stated) personnel contraception (years) for females income by women) live births) for age (% of total) (% of total) to safe water countries)+ countries)+ countries)+
developed countries)
2005 2007 2008 2007 length % wages 2006 2009 2007 2007 2007 2005 2007 2007 2008 2007 2006 2009 2007 2007 2007 2007 2006
paid
Albania 490 8 80 11 365 days 1
80, 50 (a) 0.55 7 15 49 77 43 43 41 Algeria 220 95 52 74 13 0.35 8 37 4 110 83 85 52 53 41
Australia 13,300 64 84 21 52 weeks — (b) 0.73 27 6 104 150 3 1 27 Argentina 530 99 –– 79 16 0.56 40 16 4 112 84 96 3 4 12
Austria 21,500 47 83 16 16* weeks 100 0.40 28 4 90 102 25 31 5 Armenia 980 98 20 75 12 0.55 8 24 4 98 90 98 32 40 12
Belarus 4,800 42 75 15 126 days 100 0.64 32 13 103 95 32 28 32 Azerbaijan 670 88 12 71 11 0.66 11 39 10 98 83 78 44 41 56
Belgium 7,800 74 (q) 82 16 15 weeks 82, 75 (c) 0.52 35 5 121 110 17 22 13 Bahamas 2,700 99 60 77 12 (z) 0.72 12 13 –– 98 91 97 (y) 10 10 9
Bosnia and Herzegovina 29,000 16 78 11 (z) 1 year 100 0.67 12 14 10 85 40 37 42 Bahrain 1,300 98 31(s) 78 16 0.43 3 10 9 120 102 –– 21 25 14
Bulgaria 7,400 26 77 14 135 days 90 0.66 22 12 82 105 35 34 31 Barbados 4,400 100 53 80 16 0.64 10 12 6 (y) 105 103 100 4 3 5
Canada 11,000 73 83 17 17-18 weeks 55 (d,e) 0.65 22 6 68 117 20 11 33 Belize 560 96 53 79 13 0.40 0 25 6 123 79 91 (y) 44 49 31
Croatia 10,500 –– 79 14 1+ year 100 (f,g) 0.69 21 6 50 91 29 26 35 Bolivia 89 67 35 68 11 (z) 0.58 17 57 8 109 82 86 44 44 50
Czech Republic 18,100 63 80 15 28* weeks 69 0.60 16 4 114 96 23 27 11 Botswana 130 94 42 50 12 0.67 11 40 13 107 76 96 37 31 43
Denmark 17,800 72 81 17 52 weeks 100 (d) 0.74 38 4 95 120 5 6 19 Brazil 370 88 70 76 15 0.56 9 22 5 137 105 91 16 14 23
Estonia 2,900 56 77 17 140* days1 100 0.63 21 6 93 100 19 23 13 Brunei Darussalam 2,900 99 –– 80 14 0.42 –– 9 –– 106 97 –– — — —
Finland 8,500 75 83 18 105 days 11
70 0.72 42 4 62 112 7 7 21 Cameroon 24 63 13 51 8 0.50 14 148 19 110 25 70 71 70 76
France 6,900 77 84 17 16* weeks 100 (d) 0.62 18 4 116 114 11 13 4 Chile 3,200 100 58 82 14 0.41 15 9 1 104 91 95 15 20 2
Germany 19,200 66 82 16 (z) 14* weeks 100 0.61 32 4 106 102 9 12 3 China 1,300 98 90 75 11 0.65 21 22 7 111 76 88 14 13 39
Greece 25,900 34 82 17 119 days 100 0.53 15 4 69 103 21 21 16 Colombia 290 96 68 77 13 0.62 8 20 7 116 85 93 18 16 34
Hungary 13,300 68 78 16 24* weeks 70 0.67 11 7 86 96 26 25 23 Congo 22 83 13 57 8 0.50 7 125 14 106 43 71 68 65 71
Iceland 12,700 –– 83 19 3 months 80 0.73 33 3 96 110 4 5 6 Costa Rica 1,400 99 71 81 12 0.56 37 11 5 110 87 98 9 11 11
Ireland 47,600 –– 81 18 18 weeks 70 0.58 13 4 — 112 8 8 20 Côte d’Ivoire 27 57 7 49 5 (z) 0.32 9 127 20 72 25 81 74 76 77
Italy 26,600 39 84 17 5 months 80 0.49 21 4 104 100 16 24 2 Cuba 1,400 100 72 81 19 0.45 43 7 4 102 93 91 1 2 10
Japan 11,600 44 86 15 14 weeks 60 0.46 9 4 86 101 34 36 8 Cyprus 6,400 100 (y) –– 82 14 0.60 14 5 –– 102 97 100 5 6 1
Latvia 8,500 39 78 17 112 days 1
100 0.67 20 9 89 99 24 18 25 Dominican Republic 230 98 66 76 13 0.44 20 38 5 107 79 95 28 30 29
Lithuania 7,800 31 78 17 126* days1 100 0.72 18 8 69 99 22 17 28 Ecuador 170 99 58 78 11 (z) 0.57 28 (iii) 22 9 117 68 95 19 21 37
Luxembourg 5,000 –– 82 14 16 weeks 100 0.55 23 3 88 96 28 34 9 Egypt 230 74 57 74 10 (z) 0.25 2 36 6 105 88 98 61 67 22
Macedonia, the former Yugoslav Republic of 6,500 10 77 12 9 months — (h) 0.49 28 17 33 84 42 41 43 El Salvador 190 92 61 75 12 0.50 19 24 10 118 65 84 39 33 54
Malta 8,300 –– 81 15 14 weeks 100 (j) 0.53 9 5 97 99 29 33 7 Fiji 160 99 –– 71 13 0.49 –– 18 8 (y) 94 82 47 — — 64
Moldova, Republic of 3,700 44 73 12 126 days 1
100 0.63 22 18 70 83 41 40 40 Gabon 53 86 12 57 13 (z) 0.58 17 91 12 152 55 87 58 41 72
Montenegro 4,500 ‡ — 77 — –– –– 0.54 11 10 — — — — — Georgia 1,100 98 27 75 13 0.33 6 30 2 99 90 99 49 58 8
Netherlands 10,200 76 82 16 16 weeks 100 (d) 0.66 41 5 90 118 10 9 26 Ghana 45 50 19 61 9 0.71 8 115 18 98 49 80 64 59 70
New Zealand 5,900 71 82 20 14 weeks 100 (d) 0.72 34 6 92 120 6 3 30 Guatemala 71 41 34 74 10 0.33 12 39 23 113 56 96 66 69 61
Norway 7,700 69 83 18 42-52* weeks 80, 100 (k) 0.79 36 4 90 113 2 3 11 Guyana 90 83 34 70 13 0.47 30 60 12 115 105 93 33 33 49
Poland 10,600 19 80 16 16* weeks 100 0.60 20 7 57 100 31 29 28 Honduras 93 67 56 74 12 0.46 23 24 11 117 61 84 44 45 53
Portugal 6,400 63 81 16 120 days 100 0.61 28 4 79 97 18 18 15 India 70 47 49 67 9 0.32 9 72 46 112 55 89 70 73 73
Romania 3,200 38 76 14 126 days 85 0.70 11 15 72 86 36 32 38 Indonesia 97 72 57 73 11 0.46 12 31 28 114 66 80 58 54 66
Russian Federation 2,700 47 73 14 140 days1 100 0.63 14 15 87 84 37 37 37 Iran, Islamic Republic of 300 97 56 73 13 0.41 3 33 11 121 73 94 (y) 49 45 45
Serbia 4,500 ‡ 19 76 11 (z) 365 days 100 (l) 0.56 22 8 59 88 38 42 36 Iraq 72 89 33 62 8 –– 26 44 8 99 45 77 — — 60
Slovakia 13,800 41 79 15 28* weeks 55 0.59 19 8 93 96 32 30 24 Israel 7,800 99(y) 52(t) 83 16 0.67 18 5 –– 110 92 100 2 1 2
Slovenia 14,200 59 82 17 105 days 100 0.62 13 4 81 95 15 13 17 Jamaica 240 97 66 75 12 0.57 13 31 4 95 87 93 23 24 28
Spain 16,400 66 84 17 16* weeks 100 0.53 36 4 121 119 11 13 10 Jordan 450 99 41 75 13 0.31 6 24 4 97 89 98 44 56 15
Sweden 17,400 65 83 17 480 days 80 (m,d) 0.84 47 3 95 103 1 2 1 Kazakhstan 360 100 53 73 16 0.68 16 32 4 105 93 96 8 7 16
Switzerland 13,800 78 84 15 14 weeks 80 (d) 0.66 29 5 99 93 14 16 17 Kenya 39 42 32 55 9 0.82 10 121 20 106 50 57 62 48 75
Ukraine 5,200 38 74 15 126 days 100 0.58 8 24 94 94 39 39 39 Korea, Democratic People’s Republic of 140 97 58 69 –– –– 20 55 23 –– –– 100 — — —
United Kingdom 8,200 82 (r) 82 17 52 weeks 90 (n) 0.70 20 6 72 98 13 10 21 Korea, Republic of 6,100 100 67 82 15 0.52 14 5 –– 105 98 92 (y) 7 8 6
United States 4,800 68 81 16 12 weeks — (p) 0.64 17 (iv) 8 61 94 27 18 34 Kuwait 9,600 98 39(s) 80 13 0.40 3 (vi) 11 10 96 89 –– 27 23 27
TIER II continued Women’s Index Children’s Index Rankings TIER III Women’s Index Children’s Index Rankings
Development Group Health Status Educational Economic Political Development Group Health Status Educational Economic Political
Status Children’s Status SOWM 2009 Status Children’s Status SOWM 2009
Status Status Status Status
Lifetime risk Expected Participation Percent of Lifetime risk Expected Participation Percent of
of maternal Percent of number of Ratio of of women Under-5 children under Gross Gross of maternal Percent of number of Ratio of of women Under-5 children under Gross Ratio of
LESS DEVELOPED LEAST DEVELOPED
mortality births Percent of Female life years of estimated in national mortality 5 moderately primary secondary Percent of Mothers’ Women’s Children’s mortality births Percent of Female life years of estimated in national mortality 5 moderately primary girls to boys Percent of Mothers’ Women’s Children’s
COUNTRIES and COUNTRIES
(1 in attended by women using expectancy formal female to government rate or severely enrollment enrollment population Index Rank Index Rank Index Rank (1 in attended by women using expectancy formal female to government rate or severely enrollment enrolled in population Index Rank Index Rank Index Rank
TERRITORIES
number skilled health modern at birth schooling male earned (% seats held (per 1,000 underweight ratio ratio with access (out of 75 (out of 76 (out of 79 number skilled health modern at birth schooling male earned (% seats held (per 1,000 underweight ratio primary with access (out of 40 (out of 40 (out of 43
(minus least developed
stated) personnel contraception (years) for females income by women) live births) for age (% of total) (% of total) to safe water countries)+ countries)+ countries)+ stated) personnel contraception (years) for females income by women) live births) for age (% of total) school to safe water countries)+ countries)+ countries)+
countries)
2005 2007 2007 2008 2007 2006 2009 2007 2007 2007 2007 2006 2005 2007 2007 2008 2007 2006 2009 2007 2007 2007 2007 2006
Kyrgyzstan 240 98 49 70 13 0.58 26 38 3 95 86 89 17 17 32 Afghanistan 8 14 9 44 4 –– 28 257 39 101 0.59 22 — — 43

Lebanon 290 98 37 74 14 0.32 5 29 4 95 81 100 49 55 18 Angola 12 47 5 44 3 (z) 0.62 37 158 31 194 0.93 51 33 30 39
Libyan Arab Jamahiriya 350 94 26 77 17 0.31 8 18 5 110 94 72 (y) 39 36 46 Bangladesh 51 18 47 65 8 0.46 6 (v) 61 46 103 1.03 80 20 18 13
Malaysia 560 98 30(w) 77 13 0.44 11 11 8 100 69 99 36 43 20 Benin 20 74 7 58 6 0.47 11 123 23 96 0.83 65 28 31 15
Mauritius 3,300 98 41 76 13 0.42 17 15 15 101 88 100 25 28 26 Bhutan 55 56 31 68 10 0.51 9 84 19 102 0.98 81 8 10 2
Mexico 670 93 67 79 13 0.42 23 35 5 113 87 95 20 27 25 Burkina Faso 22 54 9 54 5 0.66 15 191 37 65 0.84 72 29 26 36
Micronesia, Federated States of — 88 — 74 12 (z) — 0 40 15 110 91 94 — — 47 Burundi 16 34 9 51 7 0.77 31 180 39 103 0.91 71 14 11 25
Mongolia 840 99 58 70 14 0.60 4 43 6 100 92 72 29 17 50 Cambodia 48 44 27 62 9 0.75 16 91 36 119 0.93 65 6 2 21
Morocco 150 63 55 74 9 0.25 11 34 10 107 56 83 65 71 57 Cape Verde 120 78 46 75 12 0.36 18 32 14 (y) 101 0.94 80 (y) 2 4 1
Namibia 170 81 43 53 11 0.56 27 68 24 109 59 93 53 45 65 Central African Republic 25 53 7 46 –– 0.61 11 172 29 71 0.70 66 — — 33
Nicaragua 150 74 66 76 11 0.32 19 35 7 116 66 79 56 60 58 Chad 11 14 2 51 4 0.66 5 209 37 76 0.68 48 38 33 41
Nigeria 18 35 8 47 7 0.40 7 189 29 95 32 47 75 75 78 Comoros 52 62 19 68 7 0.50 3 66 25 85 0.88 85 16 19 6
Occupied Palestinian Territory — 99 39 75 14 0.12 –– 27 3 80 92 89 — — 39 Congo, Democratic Republic of the 13 74 4 48 4 (z) 0.51 8 161 31 61 0.78 46 36 35 38
Oman 420 98 18 (s) 78 12 0.20 0 12 18 80 90 79 (y) 67 66 61 Djibouti 35 61 18 56 4 0.48 14 127 29 44 0.81 92 31 34 20
Pakistan 74 39 20 66 6 0.30 23 90 38 92 33 90 72 74 74 Equatorial Guinea 28 65 –– 53 9 0.43 6 206 19 122 0.95 43 27 24 32
Panama 270 91 54 (y) 78 14 0.62 17 23 8 113 70 92 12 12 35 Eritrea 44 28 5 60 4 0.50 22 70 40 62 0.81 60 32 32 29
Papua New Guinea 55 41 20 60 6 (z) 0.70 1 65 35 (y) 55 — 40 73 68 79 Ethiopia 27 6 14 54 7 0.61 22 119 38 91 0.88 42 26 23 34
Paraguay 170 77 61 74 12 0.60 13 29 4 111 66 77 38 28 50 Gambia 32 57 9 61 7 0.54 9 109 20 74 1.08 86 17 21 8
Peru 140 71 48 74 14 0.56 29 20 5 116 94 84 13 14 30 Guinea 19 38 6 58 7 0.67 — (i) 150 26 91 0.85 70 22 20 21
Philippines 140 60 33 74 12 0.61 21 28 28 110 83 93 42 32 59 Guinea-Bissau 13 39 4 48 4 0.51 10 198 19 70 0.67 57 37 38 34
Qatar 2,700 99 32 (s) 77 14 0.25 0 15 6 109 103 100 43 56 6 Haiti 44 26 25 63 –– 0.53 4 76 22 –– — 58 — — —
Saudi Arabia 1,400 91 29 75 13 (z) 0.17 0 25 14 — — 95 (y) — 64 — Lao People’s Democratic Republic 33 19 29 66 8 0.51 25 70 37 116 0.89 60 17 15 24
Singapore 6,200 100 53 82 –– 0.52 25 3 3 — — 100 (y) — — — Lesotho 45 55 35 42 10 0.53 25 84 20 114 1.00 78 6 9 4
South Africa 110 92 60 50 13 0.45 33 (ii) 59 12 103 96 93 31 33 44 Liberia 12 51 6 47 8 0.50 13 133 26 91 0.90 64 23 27 19
Sri Lanka 850 99 50 76 12 (z) 0.39 6 21 29 108 87 82 54 51 63 Madagascar 38 51 18 62 9 0.70 8 112 42 141 0.97 47 12 8 31
Suriname 530 90 41 74 13 0.41 26 29 10 119 80 92 33 37 42 Malawi 18 54 39 48 9 0.74 13 111 21 116 1.04 76 5 6 9
Swaziland 120 69 46 39 10 0.34 14 91 7 106 47 60 68 71 69 Maldives 200 84 34 70 12 0.52 12 30 30 116 0.97 83 1 1 3
Syrian Arab Republic 210 93 43 76 11 (z) 0.34 12 17 10 126 72 89 58 62 55 Mali 15 45 6 57 5 0.66 10 196 32 83 0.80 60 30 25 37
Tajikistan 160 83 33 70 10 0.58 18 67 17 100 84 67 55 50 67 Mauritania 22 57 5 66 8 0.52 22 119 32 103 1.06 60 19 17 21
Thailand 500 97 70 75 14 0.62 12 7 9 106 83 98 11 9 16 Mozambique 45 48 12 43 7 0.81 35 168 24 105 0.86 42 10 7 29
Trinidad and Tobago 1,400 98 33 72 11 0.47 27 35 6 95 76 94 33 38 37 Myanmar 110 57 33 65 8 0.61 — 103 32 114 1.01 80 — — 10
Tunisia 500 90 53 76 14 0.30 23 21 4 108 85 94 30 38 20 Nepal 31 19 44 65 8 0.50 33 55 45 126 0.99 89 11 13 11
Turkey 880 83 43 74 11 0.28 9 23 4 94 79 97 57 63 23 Niger 7 33 5 56 3 0.56 12 176 44 51 0.74 42 40 37 42
Turkmenistan 290 100 53 68 –– 0.64 — 50 11 –– –– 72 (y) — — — Rwanda 16 39 10 48 9 0.73 56 181 23 147 1.01 65 4 5 17
United Arab Emirates 1,000 99 24 (s) 82 13 0.25 23 8 14 107 92 100 41 52 19 Senegal 21 52 10 65 6 (z) 0.55 22 114 17 84 1.00 77 15 22 7
Uruguay 2,100 100 75 80 16 0.57 12 14 5 115 101 100 6 5 2 Sierra Leone 8 43 4 44 6 0.45 13 262 30 147 0.90 53 39 36 40
Uzbekistan 1,400 100 59 71 11 0.60 18 41 5 95 102 88 22 22 32 Solomon Islands 100 85 –– 64 8 0.51 0 70 21 101 0.96 70 9 12 5
Venezuela, Bolivarian Republic of 610 95 62 77 12 0.54 19 19 5 106 79 83 (y) 25 25 35 Somalia 12 33 1 50 –– –– — 142 36 –– –– 29 — — —
Vietnam 280 88 57 76 10 0.71 26 15 20 103 66 92 23 19 48 Sudan 53 87 6 60 5 (z) 0.25 18 109 41 66 0.86 70 34 39 26
Zimbabwe 43 (z) 69 58 43 9 0.58 (y) 15 90 17 101 40 81 63 61 68 Tanzania, United Republic of 24 43 20 54 5 (z) 0.72 30 116 22 110 0.97 55 13 14 14
Note: Data refer to the year specified in the column heading or the most recently available. – No data ' calendar days '' working days (all other days unspecified) Timor-Leste 35 18 9 62 10 (z) 0.47 29 97 49 91 0.94 62 21 16 27
+ The Mothers’ Index rankings include only those countries for which sufficient data were available to calculate both the Women’s and Children’s Indexes.The Women’s Index and Children’s Index ranks, however, include additional countries for which adequate data were available to present findings on either women’s or
children's indicators, but not both. For complete methodology see Methodology and Research Notes. Togo 38 62 9 60 7 0.43 11 100 26 97 0.86 59 25 29 16
‡ Data refer to Serbia and Montenegro prior to its separation into two independent states in June 2006.
Uganda 25 42 18 53 10 0.71 31 130 20 117 1.01 64 3 3 11
(i) The parliament was dissolved following the December 2008 coup; (ii) Figures calculated on the basis of permanent seats only; (iii) Data refer to the transitional period. Elections to the National Assembly are due to take place in April 2009; (iv) The total refers to all voting members of the House ; (v) 45 seats
reserved for women are yet to be filled; (vi) No women were elected in 2008, however two women were appointed to the cabinet and also sit in parliament. Yemen 39 36 13 65 7 0.30 0 73 46 87 0.74 66 35 39 28
(a) 80% prior to birth and for 150 days, and 50% for the rest of the leave period; (b) A lump sum payment is paid for each child; (c) 82% for the first 30 days and 75% for the remaining period; (d) Up to a ceiling; (e) Duration depends on the province; (f) 45 days before delivery and 1 year after; (g) 100% until the child
reaches 6 months, then at a predefined level for the remaining period; (h) Paid amount not specified; (j) 13 weeks coverage; (k) 100% for 44-week option; 80% for 54-week option; (l) 100% of earnings paid with 6 months continuous coverage; 60% with 3-6 months; 30% with at least 3 months; (m) 480 calendar days Zambia 27 43 23 43 7 0.54 15 170 19 119 0.97 58 24 28 17
paid parental leave (shared between both parents): 80% for 390 days; flat rate for remaining 90; (n) Paid for up to 39 weeks: 90% for the first 6 weeks and a flat rate for the remaining weeks; (p) There is no national program. Cash benefits may be provided at the state level; (q) Data pertain to the Flemish population; (r)
Data excludes Northern Ireland; (s) Data pertain to the nationals of the country; (t) Data pertain to the Jewish population; (w) Data pertain to Peninsular Malaysia; (y) Data are from an earlier publication of the same source; (z) Data differ from the standard definition and/or are from a secondary source.
* These countries also offer prolonged periods of parental leave (at least 2 years) at lower levels of pay. For additional information on child-related leave entitlements see OECD Family database: www.oecd.org/els/social/family/database
TIER II continued Women’s Index Children’s Index Rankings TIER III Women’s Index Children’s Index Rankings
Development Group Health Status Educational Economic Political Development Group Health Status Educational Economic Political
Status Children’s Status SOWM 2009 Status Children’s Status SOWM 2009
Status Status Status Status
Lifetime risk Expected Participation Percent of Lifetime risk Expected Participation Percent of
of maternal Percent of number of Ratio of of women Under-5 children under Gross Gross of maternal Percent of number of Ratio of of women Under-5 children under Gross Ratio of
LESS DEVELOPED LEAST DEVELOPED
mortality births Percent of Female life years of estimated in national mortality 5 moderately primary secondary Percent of Mothers’ Women’s Children’s mortality births Percent of Female life years of estimated in national mortality 5 moderately primary girls to boys Percent of Mothers’ Women’s Children’s
COUNTRIES and COUNTRIES
(1 in attended by women using expectancy formal female to government rate or severely enrollment enrollment population Index Rank Index Rank Index Rank (1 in attended by women using expectancy formal female to government rate or severely enrollment enrolled in population Index Rank Index Rank Index Rank
TERRITORIES
number skilled health modern at birth schooling male earned (% seats held (per 1,000 underweight ratio ratio with access (out of 75 (out of 76 (out of 79 number skilled health modern at birth schooling male earned (% seats held (per 1,000 underweight ratio primary with access (out of 40 (out of 40 (out of 43
(minus least developed
stated) personnel contraception (years) for females income by women) live births) for age (% of total) (% of total) to safe water countries)+ countries)+ countries)+ stated) personnel contraception (years) for females income by women) live births) for age (% of total) school to safe water countries)+ countries)+ countries)+
countries)
2005 2007 2007 2008 2007 2006 2009 2007 2007 2007 2007 2006 2005 2007 2007 2008 2007 2006 2009 2007 2007 2007 2007 2006
Kyrgyzstan 240 98 49 70 13 0.58 26 38 3 95 86 89 17 17 32 Afghanistan 8 14 9 44 4 –– 28 257 39 101 0.59 22 — — 43

Lebanon 290 98 37 74 14 0.32 5 29 4 95 81 100 49 55 18 Angola 12 47 5 44 3 (z) 0.62 37 158 31 194 0.93 51 33 30 39
Libyan Arab Jamahiriya 350 94 26 77 17 0.31 8 18 5 110 94 72 (y) 39 36 46 Bangladesh 51 18 47 65 8 0.46 6 (v) 61 46 103 1.03 80 20 18 13
Malaysia 560 98 30(w) 77 13 0.44 11 11 8 100 69 99 36 43 20 Benin 20 74 7 58 6 0.47 11 123 23 96 0.83 65 28 31 15
Mauritius 3,300 98 41 76 13 0.42 17 15 15 101 88 100 25 28 26 Bhutan 55 56 31 68 10 0.51 9 84 19 102 0.98 81 8 10 2
Mexico 670 93 67 79 13 0.42 23 35 5 113 87 95 20 27 25 Burkina Faso 22 54 9 54 5 0.66 15 191 37 65 0.84 72 29 26 36
Micronesia, Federated States of — 88 — 74 12 (z) — 0 40 15 110 91 94 — — 47 Burundi 16 34 9 51 7 0.77 31 180 39 103 0.91 71 14 11 25
Mongolia 840 99 58 70 14 0.60 4 43 6 100 92 72 29 17 50 Cambodia 48 44 27 62 9 0.75 16 91 36 119 0.93 65 6 2 21
Morocco 150 63 55 74 9 0.25 11 34 10 107 56 83 65 71 57 Cape Verde 120 78 46 75 12 0.36 18 32 14 (y) 101 0.94 80 (y) 2 4 1
Namibia 170 81 43 53 11 0.56 27 68 24 109 59 93 53 45 65 Central African Republic 25 53 7 46 –– 0.61 11 172 29 71 0.70 66 — — 33
Nicaragua 150 74 66 76 11 0.32 19 35 7 116 66 79 56 60 58 Chad 11 14 2 51 4 0.66 5 209 37 76 0.68 48 38 33 41
Nigeria 18 35 8 47 7 0.40 7 189 29 95 32 47 75 75 78 Comoros 52 62 19 68 7 0.50 3 66 25 85 0.88 85 16 19 6
Occupied Palestinian Territory — 99 39 75 14 0.12 –– 27 3 80 92 89 — — 39 Congo, Democratic Republic of the 13 74 4 48 4 (z) 0.51 8 161 31 61 0.78 46 36 35 38
Oman 420 98 18 (s) 78 12 0.20 0 12 18 80 90 79 (y) 67 66 61 Djibouti 35 61 18 56 4 0.48 14 127 29 44 0.81 92 31 34 20
Pakistan 74 39 20 66 6 0.30 23 90 38 92 33 90 72 74 74 Equatorial Guinea 28 65 –– 53 9 0.43 6 206 19 122 0.95 43 27 24 32
Panama 270 91 54 (y) 78 14 0.62 17 23 8 113 70 92 12 12 35 Eritrea 44 28 5 60 4 0.50 22 70 40 62 0.81 60 32 32 29
Papua New Guinea 55 41 20 60 6 (z) 0.70 1 65 35 (y) 55 — 40 73 68 79 Ethiopia 27 6 14 54 7 0.61 22 119 38 91 0.88 42 26 23 34
Paraguay 170 77 61 74 12 0.60 13 29 4 111 66 77 38 28 50 Gambia 32 57 9 61 7 0.54 9 109 20 74 1.08 86 17 21 8
Peru 140 71 48 74 14 0.56 29 20 5 116 94 84 13 14 30 Guinea 19 38 6 58 7 0.67 — (i) 150 26 91 0.85 70 22 20 21
Philippines 140 60 33 74 12 0.61 21 28 28 110 83 93 42 32 59 Guinea-Bissau 13 39 4 48 4 0.51 10 198 19 70 0.67 57 37 38 34
Qatar 2,700 99 32 (s) 77 14 0.25 0 15 6 109 103 100 43 56 6 Haiti 44 26 25 63 –– 0.53 4 76 22 –– — 58 — — —
Saudi Arabia 1,400 91 29 75 13 (z) 0.17 0 25 14 — — 95 (y) — 64 — Lao People’s Democratic Republic 33 19 29 66 8 0.51 25 70 37 116 0.89 60 17 15 24
Singapore 6,200 100 53 82 –– 0.52 25 3 3 — — 100 (y) — — — Lesotho 45 55 35 42 10 0.53 25 84 20 114 1.00 78 6 9 4
South Africa 110 92 60 50 13 0.45 33 (ii) 59 12 103 96 93 31 33 44 Liberia 12 51 6 47 8 0.50 13 133 26 91 0.90 64 23 27 19
Sri Lanka 850 99 50 76 12 (z) 0.39 6 21 29 108 87 82 54 51 63 Madagascar 38 51 18 62 9 0.70 8 112 42 141 0.97 47 12 8 31
Suriname 530 90 41 74 13 0.41 26 29 10 119 80 92 33 37 42 Malawi 18 54 39 48 9 0.74 13 111 21 116 1.04 76 5 6 9
Swaziland 120 69 46 39 10 0.34 14 91 7 106 47 60 68 71 69 Maldives 200 84 34 70 12 0.52 12 30 30 116 0.97 83 1 1 3
Syrian Arab Republic 210 93 43 76 11 (z) 0.34 12 17 10 126 72 89 58 62 55 Mali 15 45 6 57 5 0.66 10 196 32 83 0.80 60 30 25 37
Tajikistan 160 83 33 70 10 0.58 18 67 17 100 84 67 55 50 67 Mauritania 22 57 5 66 8 0.52 22 119 32 103 1.06 60 19 17 21
Thailand 500 97 70 75 14 0.62 12 7 9 106 83 98 11 9 16 Mozambique 45 48 12 43 7 0.81 35 168 24 105 0.86 42 10 7 29
Trinidad and Tobago 1,400 98 33 72 11 0.47 27 35 6 95 76 94 33 38 37 Myanmar 110 57 33 65 8 0.61 — 103 32 114 1.01 80 — — 10
Tunisia 500 90 53 76 14 0.30 23 21 4 108 85 94 30 38 20 Nepal 31 19 44 65 8 0.50 33 55 45 126 0.99 89 11 13 11
Turkey 880 83 43 74 11 0.28 9 23 4 94 79 97 57 63 23 Niger 7 33 5 56 3 0.56 12 176 44 51 0.74 42 40 37 42
Turkmenistan 290 100 53 68 –– 0.64 — 50 11 –– –– 72 (y) — — — Rwanda 16 39 10 48 9 0.73 56 181 23 147 1.01 65 4 5 17
United Arab Emirates 1,000 99 24 (s) 82 13 0.25 23 8 14 107 92 100 41 52 19 Senegal 21 52 10 65 6 (z) 0.55 22 114 17 84 1.00 77 15 22 7
Uruguay 2,100 100 75 80 16 0.57 12 14 5 115 101 100 6 5 2 Sierra Leone 8 43 4 44 6 0.45 13 262 30 147 0.90 53 39 36 40
Uzbekistan 1,400 100 59 71 11 0.60 18 41 5 95 102 88 22 22 32 Solomon Islands 100 85 –– 64 8 0.51 0 70 21 101 0.96 70 9 12 5
Venezuela, Bolivarian Republic of 610 95 62 77 12 0.54 19 19 5 106 79 83 (y) 25 25 35 Somalia 12 33 1 50 –– –– — 142 36 –– –– 29 — — —
Vietnam 280 88 57 76 10 0.71 26 15 20 103 66 92 23 19 48 Sudan 53 87 6 60 5 (z) 0.25 18 109 41 66 0.86 70 34 39 26
Zimbabwe 43 (z) 69 58 43 9 0.58 (y) 15 90 17 101 40 81 63 61 68 Tanzania, United Republic of 24 43 20 54 5 (z) 0.72 30 116 22 110 0.97 55 13 14 14
Note: Data refer to the year specified in the column heading or the most recently available. – No data ' calendar days '' working days (all other days unspecified) Timor-Leste 35 18 9 62 10 (z) 0.47 29 97 49 91 0.94 62 21 16 27
+ The Mothers’ Index rankings include only those countries for which sufficient data were available to calculate both the Women’s and Children’s Indexes.The Women’s Index and Children’s Index ranks, however, include additional countries for which adequate data were available to present findings on either women’s or
children's indicators, but not both. For complete methodology see Methodology and Research Notes. Togo 38 62 9 60 7 0.43 11 100 26 97 0.86 59 25 29 16
‡ Data refer to Serbia and Montenegro prior to its separation into two independent states in June 2006.
Uganda 25 42 18 53 10 0.71 31 130 20 117 1.01 64 3 3 11
(i) The parliament was dissolved following the December 2008 coup. (ii) Figures calculated on the basis of permanent seats only; (iii) Data refer to the transitional period. Elections to the National Assembly are due to take place in April 2009; (iv) The total refers to all voting members of the House ; (v) 45 seats
reserved for women are yet to be filled ; (vi) No women were elected in 2008, however two women were appointed to the cabinet and also sit in parliament. Yemen 39 36 13 65 7 0.30 0 73 46 87 0.74 66 35 39 28
(a) 80% prior to birth and for 150 days, and 50% for the rest of the leave period; (b) A lump sum payment is paid for each child; (c) 82% for the first 30 days and 75% for the remaining period; (d) Up to a ceiling; (e) Duration depends on the province; (f) 45 days before delivery and 1 year after; (g) 100% until the child
reaches 6 months, then at a predefined level for the remaining period; (h) Paid amount not specified; (j) 13 weeks coverage; (k) 100% for 44-week option; 80% for 54-week option; (l) 100% of earnings paid with 6 months continuous coverage; 60% with 3-6 months; 30% with at least 3 months; (m) 480 calendar days Zambia 27 43 23 43 7 0.54 15 170 19 119 0.97 58 24 28 17
paid parental leave (shared between both parents): 80% for 390 days; flat rate for remaining 90; (n) Paid for up to 39 weeks: 90% for the first 6 weeks and a flat rate for the remaining weeks; (p) There is no national program. Cash benefits may be provided at the state level; (q) Data pertain to the Flemish population; (r)
Data excludes Northern Ireland; (s) Data pertain to the nationals of the country; (t) Data pertain to the Jewish population; (w) Data pertain to Peninsular Malaysia; (y) Data are from an earlier publication of the same source; (z) Data differ from the standard definition and/or are from a secondary source
* These countries also offer prolonged periods of parental leave (at least 2 years) at lower levels of pay. For additional information on child-related leave entitlements see OECD Family database: www.oecd.org/els/social/family/database
Methodology and
Research Notes
School Success Indexes or above grade level was selected as the measure of school
The School Success indexes assess how well prepared success.
young children are to succeed in school in both developing Bivariate and multivariate regression analyses were used
countries and the United States. Based on a thorough review to examine the relationship between each selected indicator
of the literature, programmatic expertise and available data, of school success and factors (including influences at the
“school success” for developing countries was defined as level of the child, family and community) known to put
completion of primary school. Gross intake ratio in the last children at risk of poor academic performance. Regression
grade of primary school (GIRLG) was selected as the best models for each study group were then identified. For the
proxy for this indicator. GIRLG is the total number of new developing world, this model included rates of under-5
entrants in the last grade of primary school, regardless of survival, female literacy, fertility, and grade one repetition.
age, expressed as a percentage of the total population of the The set of indicators found to be most highly predictive of
theoretical entrance age to the last grade of primary. For the school success in the United States included the frequency
United States, the percentage of fourth graders reading at of home reading activities, incidence of single-parent families,
Indicators analyzed as part of the School Success Indexes, by model
Indicator Definition* Principal Source
Developing Countries (adjusted R-square = 0.81; independent variable coefficients all significant at 1% or better)
Out-of-school children Percentage and absolute number of children of official primary school UNESCO. EFA
age who are not enrolled in either primary or secondary schools. Global Monitoring Report 2009.
(Paris: 2009) and/or data from
UNESCO Institue for Statistics
Primary school completion Total number of new entrants in the last grade of primary education, (UIS)
(Proxy: Gross intake ratio in the regardless of age, expressed as a percentage of the population at the
last grade of primary school) theoretical entrance age to the last grade of primary.
Grade 1 repetition Proportion of pupils from a cohort enrolled in grade 1 in a given

school year who study in the same grade in the following school year.
Female literacy Percentage of females aged 15 and over who can read and write with
understanding a simple statement related to their everyday life.
Under-5 survival Probability of surviving from birth to exactly 5 years of age, UNICEF.
expressed as a percentage of all live births. State of the World’s Children 2009.
(New York: 2009)
Total fertility Average number of children who would be born to a woman if she
were to live to the end of her childbearing years (15 to 49) and bear
children at each age in accordance with prevailing age-specific fertility
rates.
U.S. States (adjusted R-square = 0.68; independent variable coefficients all significant at 5% or better)
4th grade reading achievement Percentage of 4th grade public school students who scored at or U.S. Department of Education,
above the proficient level in reading, as measured and defined by the IES, National Center for Education
Statistics (NAEP), 2007 Reading
National Assessment of Educational Progress (NAEP).** Assesment.
Home reading activities Percentage of children aged 0-5 who were read aloud to three or Child and Adolescent Health
more days during the past week by a family member. Measurement Initiative. 2003
National Survey of Children's Health
(NSCH).
Maternal mental and Percentage of children aged 0-5 living with mothers whose mental
emotional health and emotional health status is excellent or very good.
Preschool enrollment The share of children aged 3-4 enrolled in public or private nursery U.S. Census Bureau, 2007
school or kindergarten during the previous two months. American Community Survey
Children in single-parent families Percentage of children under age 5 who live with their own single
parent either in a family or subfamily.
* For specific indicator notes please refer to the corresponding Index table • Measure of school success • Independent variables
** The absolute number of 4th graders reading below grade level is estimated by multiplying the difference between 100% and this data by the total number of 4th
grade students in each state (source: National Center for Education Statistics Common Core of Data (CCD), State Nonfiscal Survey of Public Elementary/Secondary
Education, 2006-07 (version 1a)

quality of maternal mental health and preschool enrollment. make sure they master basic skills may be unjustly penalized.
For a list of indicators used to compute each index, see the Care should be taken in interpreting this indicator.
table on page 47. A number of variables – such as female literacy – are
Countries and states were ranked based on index also slow to change and therefore, it could be argued, are
scores calculated as a simple average (i.e. equal weighting) not good indicators of year-to-year progress. Similarly, the
of standard scores for indicators in each regression model. data for home reading activities and maternal mental health
Only cases with data across all variables were included. were self-reported and therefore reflect parent perceptions
Statistical analyses were performed using Microsoft Excel of their health and of family characteristics. Some parents,
and SPSS. such as highly educated mothers, for example, may give
socially desirable rather than objective responses to survey
Limitations of this study questions and as a result might overestimate reading
The complex interactions and relationships among the frequency or provide a more optimistic assessment of their
independent variables included in this study have not been mental and emotional health.
explored. Considerable associations were noted within the It should also be noted that data for out-of-school
independent variable set. Illustratively, poor maternal mental children – which are used in the narrative, but not in the
health is strongly associated with reading activities; and, model – are notoriously difficult to estimate. Both the
under-5 survival rates and fertility rates are also strongly numerator and denominator are subject to many challenges,
associated. Nevertheless, collinearity diagnostics indicate including incentives to inflate enrollments, large numbers of
that each independent variable in the model helps to explain over- or under-aged children, systems that neglect to record
some (but not all) variation in the dependent variable, school dropouts, and outdated census numbers.
success. However, with the notable exception of a few outliers,
The decision to give equal weighting to the components the regression models identified for developing countries
of the indexes reinforces the synergistic nature of the and the U.S. states work remarkably well. So, despite
interaction between these variables – the notion that no their limitations, these models remain valid and powerful
single factor exclusively enhances or limits a child’s chance of predictors of school success as we have defined it for the
school success. As a simple average, however, the index may purposes of analysis.
mask important variations among its components. Results
for indicators on which a state or country has made less Complete Mothers’ Index
progress can offset advances on others. Moreover, variables 1. In the first year of the Mothers’ Index (2000), a review
least amenable to treatment strategies (e.g. single-parent of literature and consultation with members of the
families or fertility rates) are given equal importance as Save the Children staff identified health status, educational
those that have more actionable interventions (e.g. reading status, political status and children’s well-being as key factors
at home and school enrollment). This methodology similarly related to the well-being of mothers. In 2007, the Mothers’
overstates the effectiveness of certain interventions. For Index was revised to include indicators of economic status.
example, although preschool enrollment and repetition All countries with populations over 250,000 were placed into
enhance the predictive validity of their respective model, of one of three tiers according to United Nations development
all indicators modeled, they are the least strongly correlated groups: more developed countries, less developed
with school success. countries and least developed countries. Indicators for each
The study also has several limitations with respect to development group were selected to best represent factors of
specific variables. In selecting indicators, relevance had to maternal well-being specific to that group and published data
be balanced with data availability. Existing data on primary sources for each indicator were then identified. To facilitate
school completion, for instance, are not entirely satisfactory. international comparisons, in addition to reliability and validity,
For our purposes, gross intake ratio in the last grade of indicators were selected based on inclusivity (availability
primary school (GIRLG) was the best proxy. And although across countries) and variability (ability to differentiate
GIRLG is the most widely available indicator of completion between countries). To adjust for variations in data availability
and reflects the likelihood of all children to complete when calculating the final index, indicators for maternal health
primary school (and not just those fortunate enough to and children’s well-being were grouped into sub-indices
enter school, as measured by survival rates to grades 4 or (see step 7). This procedure allowed researchers to draw
5), it can be difficult to compare across countries as the on the wealth of useful information on those topics without
last grade of school varies and some countries require exit giving too little weight to the factors for which less abundant
exams while others do not. Moreover, even though children data were available. Data presented in this report includes
may enroll in the last grade of primary school, many will not information available through 01 March 2009.
complete it. Sources: 2008 Population: United Nations Population Fund. State of World Population
The use of first grade repetition rates is particularly 2008. (New York: 2008); Classification of development regions: United Nations
Population Division. World Population Prospects: The 2008 Revision. Population Data-
problematic. Repetition rates reflect policies and traditions base available online at: esa.un.org/unpp/index.asp?panel=5
about the effectiveness of repetition as a learning strategy.
In some cases, it may be used as a screening or disincentive 2. In Tier I, data were gathered for seven indicators of
strategy to weed out low performing students. In others, women’s status and three indicators of children’s status.
low repetition rates reflect policies or practices of automatic Sufficient data existed to include analyses of two additional
promotion that obscure the reality of poor quality and indicators of children’s well-being in Tiers II and III. Indicators
school failure. As a result, countries that hold kids back to unique to specific development groups are noted below.

The Indicators That Represent Women’s Health THE INDICATOR THAT REPRESENTS WOMEN’S
Status Are: EDUCATIONAL STATUS IS:
Lifetime risk of maternal mortality Expected number of years of formal female schooling
A woman’s risk of death in childbirth over the course of Education is singularly effective in enhancing maternal health,
her life is a function of many factors, including the number women’s freedom of movement and decision-making power
of children she has and the spacing of births as well as within households. Educated women are more likely to be
the conditions under which she gives birth and her own able to earn a livelihood and support their families. They
health and nutritional status. Calculations are based on the are also more likely than uneducated women to ensure that
maternal mortality and fertility rate in a country. Some their children eat well, finish school and receive adequate
country estimates are derived using a WHO/UNICEF health care. Female school life expectancy is defined as
methodology. Data are for 2005. the number of years a female child of school entrance
Source: Maternal Mortality in 2005: Estimates Developed by WHO, age is expected to spend at school or university, including
UNICEF, UNFPA and the World Bank. (WHO: 2007) years spent on repetition. It is the sum of the age-specific
Available online at: www.who.int/whosis/mme_2005.pdf
enrollment ratios for primary, secondary, post-secondary
non-tertiary and tertiary education. Primary to secondary
Percent of women using modern contraception estimates are used where primary to tertiary are not
Access to family planning resources, including modern available. Data are from 2007 or the most recent year
contraception, allows women to plan their pregnancies. This available.
helps ensure that a mother is physically and psychologically Sources: UNESCO Institute for Statistics (UIS). Data Centre. http://stats.uis.unesco.
prepared to give birth and care for her child. Data are org, supplemented with data from UNESCO. Global Education Digest 2007. (Montreal:
2007) Table 12, pp.154-163
derived from sample survey reports and estimate the
proportion of married women (including women in
consensual unions) currently using modern methods of THE INDICATORS THAT REPRESENT WOMEN’S
contraception, which include: male and female sterilization, ECONOMIC STATUS ARE:
IUD, the pill, injectables, hormonal implants, condoms and
female barrier methods. Contraceptive prevalence data are Ratio of estimated female to male earned income
the most recent available as of November 2007. Mothers are likely to use their influence and the resources
Source: United Nations Population Division. World Contraceptive Use 2007 they control to promote the needs of their children. Where
(wall chart). Available online at: www0.un.org/esa/population/publications mothers are able to earn a decent standard of living and wield
/contraceptive2007/contraceptive2007.htm
power over economic resources, children survive and thrive.
The ratio of estimated female earned income to estimated
Skilled attendance at delivery male earned income – how much women earn relative to men
The presence of a skilled attendant at birth reduces the for equal work – reveals gender inequality in the workplace.
likelihood of both maternal and infant mortality. The Female and male earned income are crudely estimated based
attendant can help create a hygienic environment and on the ratio of the female nonagricultural wage to the male
recognize complications that require urgent medical care. nonagricultural wage, the female and male shares of the
Skilled attendance at delivery is defined as those births economically active population, the total female and male
attended by physicians, nurses or midwives. Data are from population and GDP per capita in purchasing power parity
2000-2007. As nearly every birth is attended in the more terms in US dollars. Estimates are based on data for the most
developed countries, this indicator is not included in Tier I. recent year available between 1996 and 2006.
Source: United Nations Children’s Fund (UNICEF). The State of the World’s Children Source: United Nations Development Programme (UNDP). Human Development
2009. (New York: 2009) Table 8, pp.146-149 Available online at: www.unicef.org/ Indices: A statistical update 2008. (UNDP: 2008) Table 5, pp.41-44. Available online at:
sowc09/statistics/tables.php hdr.undp.org/en/media/HDI_2008_EN_Tables.pdf
Female life expectancy Maternity leave benefits

Children benefit when mothers live longer, healthier lives. The maternity leave indicator includes both the length of
Life expectancy reflects the health, social and economic time for which benefits are provided as well the extent of
status of a mother and captures trends in falling life compensation. The data are compiled by the International
expectancy associated with the feminization of AIDS. Female Labour Office and the United States Social Security
life expectancy is defined as the average number of years of Administration from a variety of legislative and non-
life that a female can expect to live if she experiences the legislative sources from 2004 to 2006. Data on maternity
current mortality rate of the population at each age. Data leave benefits are reported for Tier I countries only,
estimates are for 2008. where women comprise a considerable share of the non-
Source: United Nations Population Fund (UNFPA). State of World Population 2009. agricultural workforce and thus most working mothers are
(New York: 2008) pp. 86-89, 94 Available online at: www.unfpa.org/swp/ free to enjoy the benefits of maternity leave.
Source: United Nations Statistics Division. Statistics and indicators on women and
men. Table 5g. Updated December 2008. Available online at: unstats.un.org/unsd/
demographic/products/indwm/tab5g.htm

THE INDICATOR THAT REPRESENTS WOMEN’S Gross primary enrollment ratio
POLITICAL STATUS IS: The gross primary enrollment ratio is the total number
of children enrolled in primary school, regardless of age,
Participation of women in national government expressed as a percentage of the total number of children
When women have a voice in public institutions, they can of official primary school age. Data are for the school year
participate directly in governance processes and advocate for ending in 2007 or the most recently available. This indicator
issues of particular importance to women and children. This is not tracked in Tier I, where nearly all children complete
indicator represents the percentage of seats in the lower or primary school.
single-house of national legislatures or parliaments occupied Source: UNESCO Institute for Statistics (UIS). Data Centre. http://stats.uis.unesco.org
by women. Data are as of 28 February 2009.
Source: Inter-Parliamentary Union (IPU). Women in National Parliaments. Available Gender parity index (GPI)
online at: www.ipu.org/wmn-e/classif.htm Educating girls is one of the most effective means of
improving the well-being of women and children. The ratio
THE INDICATORS THAT REPRESENT CHILDREN’S of gross enrollment of girls to boys in primary school – or
WELL-BEING ARE: gender parity index (GPI) – measures gender disparities in
primary school participation. It is calculated as the number
Under-5 mortality rate of girls enrolled in primary school for every 100 enrolled
Under-5 mortality rates are likely to increase dramatically boys, regardless of age. A score of 1 means equal numbers
when mothers receive little or no prenatal care and give of girls and boys are enrolled; a score between 0 and 1
birth under difficult circumstances, when infants are not indicates a disparity in favor of boys; a score greater than
exclusively breastfed, few children are immunized and fewer 1 indicates a disparity in favor of girls. Data are for the
receive preventive or curative treatment for common school year ending in 2007 or the most recently available.
childhood diseases. Under-5 mortality rate is the probability GPI is included in Tier III, where gender equity gaps
of dying between birth and exactly five years of age, disadvantaging girls in access to education are the largest in
expressed per 1,000 live births. Estimates are for 2007. the world.
Source: UNICEF. The State of the World’s Children 2009. (New York: 2009) Table 1, Source: UNESCO Institute for Statistics (UIS). Data Centre. http://stats.uis.unesco.org
pp.118-121. Available online at: www.unicef.org/sowc09/statistics/tables.php
Gross secondary enrollment ratio

Percentage of children under age 5 moderately or The gross secondary enrollment ratio is the total number
severely underweight of children enrolled in secondary school, regardless of age,
Poor nutrition affects children in many ways, including expressed as a percentage of the total number of children of
making them more susceptible to a variety of illnesses and official secondary school age. Data are for the school year
impairing their physical and cognitive development. Children ending in 2007 or the most recently available. This indicator
moderately or severely underweight are more than two and is not tracked in Tier III where many children still do not
three standard deviations below median weight for age of attend primary school, let alone transition to higher levels.
the reference population respectively. Data are from 2000- Source: UNESCO Institute for Statistics (UIS). Data Centre. http://stats.uis.unesco.org
2007. This indicator is included in Tier II and Tier III only, as
few more-developed countries report this data. Percent of population with access to safe water
Source: UNICEF. The State of the World’s Children 2009. (New York: 2009) Table 2, Safe water is essential to good health. Families need an
pp.122-125. Available online at: www.unicef.org/sowc09/statistics/tables.php adequate supply for drinking as well as cooking and washing.
Access to safe and affordable water also brings gains for
Gross pre-primary enrollment ratio gender equity, especially in rural areas where women and
Early childhood care and education (ECCE), including pre- young girls spend considerable time collecting water. This
primary schooling, supports children’s growth, development, indicator reports the percentage of the population with
learning and survival. It also contributes to proper health, access to an adequate amount of water from an improved
poverty reduction and can provide essential support for source within a convenient distance from a user’s dwelling,
working parents, particularly mothers. The pre-primary as defined by country-level standards. “Improved” water
gross enrollment ratio (GER) is the total number of children sources include household connections, public standpipes,
enrolled in pre-primary education, regardless of age, boreholes, protected dug wells, protected springs and
expressed as a percentage of the total number of children of rainwater collection. In general, “reasonable access” is
official pre-primary school age. GERs can be higher than 100 defined as at least 20 liters (5.3 gallons) per person per day,
percent when children enter school later than the official from a source within one kilometer (.62 miles) of the user’s
enrollment age or do not advance through the grades at dwelling. Data are for 2006.
expected rates. Data are for the school year ending in 2007 Source: UNICEF. The State of the World’s Children 2009. (New York:2009) Table 3,
or the most recently available. Pre-primary enrollment is pp.126-129. Available online at: www.unicef.org/sowc09/statistics/tables.php
analyzed across Tier I countries only.

Source: UNESCO Institute for Statistics (UIS). Data Centre. http://stats.uis.unesco.org

3. Missing data were supplemented when possible with data 7. The z-scores of the four indicators related to women’s
from the same source published in a previous year, as noted health were averaged to create an index score of women’s
in the fold-out table in this appendix. health status. In Tier I, an index score of women’s economic
4. Data points expressed as percentages were rounded to status was similarly calculated as a weighted average of the
the nearest tenth of one percent for analysis purposes. Data ratio of female to male earned income (75 percent), length
analysis was conducted using Microsoft Excel software. of maternity leave (12.5 percent) and percent of wages paid
5. Standard scores, or z-scores, were created for each of the (12.5 percent). An index of child well-being – the Children’s
–
indicators using the following formula: Z= ( X–X ) ⁄ S Index – was also created by first averaging indicators of
where: education, then averaging across all z-scores. At this stage,
Z = The standard, or z-score cases (countries) missing more than one indicator on
X = The score to be converted either index were eliminated from the sample. Countries
–
X = The mean of the distribution missing any one of the other indicators (that is educational,
S = The standard deviation of the distribution economic or political status) were also eliminated. A
6. The standard scores of indicators of ill-being were then Women’s Index was then calculated as a weighted average of
multiplied by (-1) so that a higher score indicated increased health status (30 percent), educational status (30 percent),
well-being on all indicators. economic status (30 percent) and political status (10
percent).
Notes on specific indicators 8. The Mothers’ Index was calculated as a weighted average
• To facilitate cross-country comparisons, length of of children’s well-being (30 percent), women’s health status
maternity leave was converted into days and allowances (20 percent), women’s educational status (20 percent),
were averaged over the entire pay period. women’s economic status (20), and women’s political status
• To avoid rewarding school systems where pupils do not (10 percent). The scores on the Mothers’ Index were then
start on time or fail to progress through the system at ranked.
expected rates, gross enrollment ratios (GERs) between NOTE: Data exclusive to mothers are not available
100 and 105 percent were discounted to 100 percent. for many important indicators (school life expectancy and
Gross enrollment ratios over 105 percent were either government positions held, for example). In these instances,
discounted to 100 with any amount over 105 percent data on women’s status have been used to approximate
subtracted from 100 (for example, a country with a gross maternal status, since all mothers are women. In areas such
enrollment rate of 107 percent would be discounted to as health, where a broader array of indicators is available,
100-(107-105), or 98) or the respective country’s net the index emphasizes indicators that address uniquely
enrollment ratio, whichever was higher. maternal issues.
• To avoid rewarding countries in which girls’ educational
progress is made at the expense of boys’, countries with
gender parity indices greater than 1.02 (an indication of
gender inequity disfavoring boys) were discounted to 1.00
with any amount over 1.02 then subtracted from 1.00.
• egypt
Endnotes
1
U NESCO. EFA Global Monitoring Report 2009. 14
See, for example: Child Trends and Center for 31
Arnold, Caroline. “Positioning ECCD in the 21st
(Paris: 2008) Table 5, p.307. 75 million is a Child Health Research. Early Child Development Century.” Coordinators’ Notebook: An International
conservative estimate. Millions more children may in Social Context. (New York: 2004) and Pamela Resource for Early Childhood Development. (The
be missing out on primary school. Recent estimates C. High and the Committee on Early Childhood, Consultative Group on Early Childhood Care and
by UNICEF place the total at 101 million. Adoption, and Dependent Care and Council on Development: Toronto: 2004) Volume 28. p.12
School Health. “School Readiness.” Pediatrics.
2
alculations by Save the Children using data from
C Volume 121, Number 4. April 2008, pp.e1008-e1015 32
orld Bank. Girls’ Education in the 21st Century:
W
the U.S. Department of Education’s National Gender Equality, Empowerment, and Economic
Center for Education Statistics Common Core 15
U NESCO. EFA Global Monitoring Report 2007. Growth. Mercy Tembon and Lucia Fort, editors.
of Data (CCD): State Nonfiscal Survey of Public (UNESCO:2006) p.1 (Washington: 2008)
Elementary/Secondary Education. 2006-07 (version
v.1a) http://nces.ed.gov/ccd/ 16
U NESCO. EFA Global Monitoring Report 2009. Table 33
Lloyd, Cynthia B. “Schooling and Adolescent
2. p.274 Reproductive Behavior in Developing Countries,”
3
NICEF. Childinfo. www.childinfo.org/education_
U background paper to Public Choices, Private
outofschool.php 17
Ibid. Decisions: Sexual and Reproductive Health and the
Millennium Development Goals. (United Nations
4
U NESCO. EFA Global Monitoring Report 2009. pp. 18
Ibid, p.11 Millennium Project: New York: 2006)
9, 307
19
roLiteracy Worldwide. The State of Adult Literacy
P 34
rown, Brett, Michael Weitzman, Martha Zaslow,
B
5
Grantham-McGregor, Sally, Santiago Cueto, Paul 2006. (Syracuse, NY: 2006) p.7 et al. Early Childhood in Social Context: A Chartbook.
Glewwe, Linda Richter, Barbara Strupp and the (Commonwealth Fund: New York: 2004)
International Child Development Steering Group. 20
S ave the Children. What’s the Difference? The
“Developmental Potential in the First 5 Years for Impact of Early Childhood Development Programs. 35
S mith, L. and L. Haddad. Overcoming Child
Children in Developing Countries.” The Lancet. (Save the Children, Children’s Environments Malnutrition in Developing Countries: Past
Volume 369, Issue 9555. January 6, 2007. p.65 Research Group and UNICEF: Kathmandu: 2003) Achievement and Future Choices, Discussion Paper
No.30 (International Food Policy Research
6
Population of children under-5: UNICEF. State of 21
ingat, A. and A. Jaramillo. Early Childhood Care
M Institute: 2000)
the World’s Children 2009. (New York: 2009) Table and Education in Sub-Saharan Africa: What Would
6, p.141 it Take to Meet the Millennium Development Goals? 36
U NICEF. State Of The World’s Children 2009. p.32
(World Bank: Washington: 2003) pp.18-19
7
runer, Charles, Victor Elias, Debbie Stein and
B 37
nowles, Stephan, Paula K. Lorelly and P. Dorian
K
Stephanie Schaefer. Early Learning Left Out: An 22
agitcibasi, C., D. Unar and S. Bekman. “Long
K Owen. “Are Educational Gender Gaps a Brake on
Examination of Public Investments in Education and Term Effects of Early Intervention: Turkish Economic Development? Some Cross-Country
Development by Child Age. (Voices for America’s Low-Income Mothers and Children.” Applied Empirical Evidence.” Oxford Economic Papers.
Children and Child and Family Policy Center: Developmental Psychology. Volume 22. 2001. Volume 54, Number 1. (2002)
Washington: February 2004) pp.333-361
38
Literacy rates were averaged across 4 of 8 East
8
ational Research Council Institute of Medicine.
N 23

University of North Carolina, FPG Child Asian “miracle” economies for which literacy data
From Neurons to Neighborhoods: The Science of Early Development Institute. The Carolina Abecedarian were available: UNESCO Institute for Statistics
Childhood Development. (National Academy Press: Project. http://www.fpg.unc.edu/~abc/ (UIS). Data Centre. http://stats.uis.unesco.org
Washington: 2000) pp.182-217
24
Heckman, James J. “Catch ‘em Young.” Wall 39
U NESCO. EFA Global Monitoring Report 2009.
9
S hore, Rima. Preventing Low Birth Weight. (Annie E. Street Journal. http://online.wsj.com/article/ Table 2. p.274
Casey Foundation: July 2005) SB113686119611542381.html?mod=opinion_main_
commentaries 40
Gross national income data adjusted for
10
alker, Susan, Theodore Wachs, Julie Meeks
W purchasing power parity (ppp). Source: The
Gardner, Betsy Lozoff , Gail Wasserman, 25
Ibid. World Bank. World Development Report 2009.
Ernesto Pollitt, Julie Carter and the International (Washington: 2009) Table 1. pp.352-353
Child Development Steering Group. “Child 26
Lynch, Robert G. Exceptional Returns: Economic,
Development: Risk Factors for Adverse Outcomes Fiscal, and Social Benefits of Investment in Early 41
Calculations based on data from: UNESCO.
in Developing Countries.” The Lancet. Volume Childhood Development. (Economic Policy Institute: EFA Global Monitoring Report 2009. Table 5.
369, Issue 9556. January 13, 2007. pp.145–57 and Washington: 2004) p.viii pp.306-307.
S. Chaikind and H. Corman. “The Impact of Low
Birthweight on Special Education Costs.” Journal 27
Van der Gaag, J. and J.P. Tan. The Benefits of Early 42
alculations by Save the Children. Figures are
C
of Health Economics. Volume 10. 1991. pp.291-311 Child Development Programs: An Economic Analysis. rough approximations based on the number of
and Adnan Bhutta, Mario Cleves, Patrick Casey, (World Bank: Washington: 1998) students enrolled at a given grade of education
Mary Cradock and K.J.S. Anand. “Cognitive and and prevailing dropout rates by grade. Data
Behavioral Outcomes of School-Aged Children 28
High/Scope Educational Research Foundation. sources: School enrollment: UNESCO Institute
Who Were Born Preterm, A Meta-analysis.” High/Scope Perry Preschool Study. http://www. for Statistics (UIS). Data Centre. http://stats.uis.
Journal of the American Medical Association. Volume highscope.org/Content.asp?ContentId=219 unesco.org; Dropout rates: UNESCO. EFA Global
288, Number 6. August 14, 2002. pp.728-737 Monitoring Report. Table 7, pp.316- 322
29
itzman, Harriet, David Olds, Kimberly Sidora,
K
11
Dee, Deborah, Ruowei Li, Li-Ching Lee and Robert Cole, John Eckenrode, Jane Powers, 43
U NESCO Institute for Statistics (UIS). Data
Laurence Grummer-Strawn. “Associations Pamela Morris, Charles Henderson, Lisa Pettitt Centre. http://stats.uis.unesco.org
Between Breastfeeding Practices and and Dennis Luckey. “Long-Term Effects of Home
Young Children’s Language and Motor Skill Visitation on Maternal Life Course and Child 44
Ibid.
Development.” Pediatrics. Volume 119. February Abuse and Neglect: Fifteen-Year Follow-Up of a
2007. pp.S92-S98 Randomized Trial.” Journal of the American Medical 45
orld Bank. World Development Report 2009.
W
Association. Volume 278, Number 8. 1997. pp.637- Tables 1 and 5. pp.352-353, 360
12
Anderson, J.W., B.M. Johnstone, D.T. Remley. 643 and Bruner, Charles. Many Happy Returns:
“Breast-Feeding and Cognitive Development: A Three Economic Models that Make the Case for 46
Meta-analysis. American Journal of Clinical Nutrition. School Readiness. The State Early Childhood Centre. http://stats.uis.unesco.org
Volume 70. October 1999. pp.525-535 Policy Technical Assistance Network (2004)
www.finebynine.org/uploaded/file/SECPTAN_ 47
Ibid.
13
Horwood, L. John and David M. Fergusson. MHR_final.pdf
“Breastfeeding and Later Cognitive and Academic 48
Ibid.
Outcomes.” Pediatrics. Volume 101, Number 1. 30
obonis, Gustavo, Edward Miguel and Charu Puri
B
January 1998. p.e9 Sharma. “Iron Deficiency Anemia and School
Participation.” Journal of Human Resources. Volume
41, Number 4. 2006. pp. 692-721

49
The 20 out of 31 are: Afghanistan, Burundi, 70
Larson, E.H., E. Murowchick and L.G. Hart. Poor 93
U NICEF Innocenti Research Centre. The Child
Cameroon, Central African Republic, Chad, Birth Outcomes in the Rural United States: 1985-1987 Care Transition: A League Table of Early Childhood
Congo, Côte d’Ivoire, DR Congo, Ethiopia, to 1995-1997. (WWAMI Rural Health Research Education and Care in Economically Advanced
Guinea, Guinea-Bissau, Lao PDR, Mali, Center: Seattle: February 2008) Countries
Mozambique, Nepal, Nigeria, Rwanda, Senegal,
Uganda and Yemen. Source: Uppsala Conflict 71
hildren’s Defense Fund. The State of America’s
C 94
Ibid.
Data Program. UCDP Database. www.pcr.uu.se/ Children 2008. p.46
research/UCDP/index.htm 95
OECD. Starting Strong II: Early Childhood Education
72
Ibid. and Care. (OECD: France: 2006)
50
Centre. http://stats.uis.unesco.org 73
.S. Census Bureau, 2007 American Community
U 96
N ational Governors Association (NGA), Council
Survey of Chief State School Officers (CCSSO) and
51
Ibid. Achieve, Inc. Benchmarking for Success: Ensuring
74
Ibid. U.S. Students Receive a World-Class Education.
52
NICEF. State of the World’s Children 2009. Table
U (Washington: 2008), p.5
2, pp.122-125 75
The Annie E. Casey Foundation. National KIDS
COUNT Program. http://datacenter.kidscount.org/ 97
NGA, CCSSO and Achieve, Inc. Benchmarking for
53
NESCO Institute for Statistics (UIS). Data
U Success: Ensuring U.S. Students Receive a World-Class
Centre. http://stats.uis.unesco.org 76
Ibid. Education. p.10
54
Ibid. 77
Reichman, Nancy E. “Low Birthweight and School 98
OECD. Highlights from Education at a Glance 2008:
Readiness.” The Future of Children, Volume 15, OECD Indicators (France: 2009) p.25
55
Ibid. Number 1. 2005 pp.90-116 and Action for Healthy
Kids. Progress or Promises? What’s Working For and 99
NGA, CCSSO and Achieve, Inc. Benchmarking for
56
Ibid. Against Healthy Schools. (Fall 2008), p.12 Success: Ensuring U.S. Students Receive a World-Class
Education. p.10
57
NAIDS. Report on the Global HIV/AIDS Epidemic
U 78
Action for Healthy Kids. Progress or Promises?
2008. (Geneva: 2008) p.33 What’s Working For and Against Healthy Schools. p.3 100
Ibid.
58
NICEF. State of the World’s Children 2009. Table
U 79
hildren’s Defense Fund. State of America’s Children
C 101
Ibid, p.14
4. p.133 2008. p.37
102
Ibid, p.16
59
Ibid. 80
Ibid.
103
Ibid.
60
orld Bank. ECD and HIV/AIDS. http://web.
W 81
enters for Disease Control and Prevention.
C
worldbank.org/WBSITE/EXTERNAL/TOPICS/ Prevalence of Overweight, Infants and Children Less 104
NICEF. Progress for Children: A Report Card on
U
EXTCY/EXTECD/0,,contentMDK:20216850~men Than 2 Years of Age: United States, 2003-2004. Maternal Mortality. (New York: September 2008)
uPK:522012~pagePK:148956~piPK:216618~theSit www.cdc.gov/nchs/products/pubs/pubd/hestats/ p.9
ePK:344939,00.html overweight/overwght_child_under02.htm
105
S ave the Children. State of the World’s Mothers
61
Fonseca, Jodie, Chloe O’Gara, Linda Sussman 82
Ogden C.L., K.M. Flegal, M.D. Carroll and C.L. 2008. (Westport, CT: 2008) pp.15-21.
and John Williamson. “New Threats to Early Johnson. “Prevalence and Trends in Overweight Calculations were derived from national-level
Childhood Development: Children Affected by Among US Children and Adolescents, 1999-2000.” estimates of the percentage and absolute number
HIV/AIDS.” Africa’s Future, Africa’s Challenge: Early Journal of the American Medical Association. Volume of children under age 5 without basic health care
Childhood Care and Development in Sub-Saharan 288, Number 14. October 9, 2002. pp.1728-1732. for all developing countries for which sufficient
Africa. (World Bank: Washington: 2008) p.96 data points were available. When taken together,
83
The Annie E. Casey Foundation. National KIDS the absolute number of children under 5 in these
62
hildren’s Defense Fund. State of America’s Children
C COUNT Program. http://datacenter.kidscount.org/ 81developing countries without basic health care
2008. (Washington: 2008) p.46 totaled more than 200 million. This number was
84
.S. Census Bureau, 2007 American Community
U 51 percent of the under-5 population in these
63
Ibid. Survey 81countries and one-third of all children under
age 5 in the world.
64
.S. Census Bureau. 2007 American Community
U 85
Ibid.
Survey. (S1401. School Enrollment) http:// 106
alculations based on data for moderate or
C
factfinder.census.gov/ 86
Ibid. severe stunting from UNICEF. State of the World’s
Children 2009. Tables 2 and 6. pp.125, 141
65
Ibid. 87
Ibid.
107
NICEF. Vitamin A Supplementation: Progress for
U
66
Ibid. 88
Duncan, Greg and Katherine Magnuson. “Can Child Survival. Working Paper (New York: 2006)
Family Socioeconomic Resources Account for p.2
67
Johnson, Jerry and Marty Strange. Why Rural Racial and Ethnic Test Score Gaps?” The Future of
Matters 2007: The Realities of Rural Education Children. Volume 15, Number 1. 2005. pp.169-96 108
alker, Susan, Susan Chang, Christine Powell
W
Growth. (The Rural School and Community Trust: and Sally Grantham-McGregor. “Effects of
Arlington, VA: October 2007) 89
Romero, Mariajosé and Young-Sun Lee. The Early Childhood Psychosocial Stimulation and
Influence of Maternal and Family Risk on Chronic Nutritional Supplementation on Cognition
68
ational Center for Children in Poverty. Basic
N Absenteeism in Early Schooling. (National Center for and Education in Growth-Retarded Jamaican
Facts About Low-Income Children: Birth to Age 6. Children in Poverty: New York: January 2008) p.4 Children: Prospective Cohort Study.” The Lancet.
(National Center for Children in Poverty: New Volume 366, Issue 9499. October 19, 2005.
York: September 2007) and U.S. Department of 90
Ibid. pp.1804-1807
Health and Human Services, Health Resources
and Services Administration, Maternal and Child 91
Duncan, Greg J. and Katherine Magnuson. “Can 109
Ruel, Marie and John Hoddinott. Investing in Early
Health Bureau. The National Survey of Children’s Family Socioeconomic Resources Account for Childhood Nutrition. (International Food Policy
Health 2003. (HHS: Rockville, MD: 2005) pp.18, Racial and Ethnic Test Score Gaps?” Research Institute: Washington: 2008)
42
92
S ee UNICEF Innocenti Research Centre. The Child 110
The category “more developed” nations includes
69
.S. Department of Health and Human Services,
U Care Transition: A League Table of Early Childhood countries in all regions of Europe, including
Health Resources and Services Administration, Education and Care in Economically Advanced Central and Eastern European countries as well as
Maternal and Child Health Bureau. The National Countries. (Florence, Italy: 2008) the Baltic States, plus North America, Australia,
Survey of Children's Health 2003. pp.13, 28, 30 New Zealand and Japan.

Credits
Managing Editor/Writer Page 3 – Karin Epstein

Tracy Geoghegan Haiti. Save the Children President Charles MacCormack and
preschoolers at the Republique de Venezuela School in Port au
Principal Advisers Prince share a shaping moment.
Chloe O’Gara, Judith Jerald, Pablo Stansbery
Page 4 – Brent Stirton
Research Directors Nepal. Krishna never went to school but she is determined to
Beryl Levinger, Nikki Gillette help her 5-year-old daughter Sarita have better opportunities.
Sarita is one of the brightest students at an ECD center
Research Assistants supported by Save the Children in Nimuwaboshi village.
Rubayica Srivastava, Theresa Williams
Page 8 – Michael Bisceglie
Contributors Philippines. A young boy plays with burning garbage beside the
Rosemary Akech, Julee Allen, Linda Askew, Eileen Burke, railroad tracks in Victoria Ville, near Manila.
Gersande Chavez, Wendy Christian, Tory Clawson, Cathy
Coddington, Kate Conradt, Hari Dongol, Steven Fisher, Page 12 – Brent Stirton
Jodie Fonseca, Paula Hale, Candace Hanau, Alfreda Haskie, Nepal. ECD facilitator Hariram Chaudhary holds up a mirror
Andrew Hysell, Binod Jairu, Lois Jensen, Udaya Laxmi, to show 4-year-old Naisha her reflection. This preschool in
Karina López, Melissa Kelly, Mike Kiernan, Suzanna Klaucke, Nimuwaboshi village is supported by Save the Children.
Michael Klosson, Vivica Kraak, Joy Lawn, Lisa Long, Carolyn
Miles, Carol Miller, Diana Myers, Joyce Newman, James Page 13 – Jenny Matthews
Nichols, Natalie Vega O'Neil, David Oot, Veronica Pollard, Ethiopia. Getahun works on his writing skills at a preschool
Ryan Quinn, Carmen Ramos, Jennifer Rigg, Rocío Rodriguez, supported by Save the Children in a part of Addis Ababa that has
Sanjana Shrestha, Mark Shriver, Karen Spencer, Tanya been hit hard by HIV.
Weinberg, Betsy Zorio
Page 15 – Ahmed El Nemr
Administrative Coordinator Egypt. 4-year-old Hagar enjoys coloring a picture at a preschool
Sue Lewis supported by Save the Children in Minya.
Design Page 16 – Michael Bisceglie

Spirals, Inc. Mozambique. Preschool teacher Rute reads to 4-year-old
Madalena in one of the new Save the Children ECD centers
Photo Editor established with donations from America Idol viewers.
Susan Warner
Page 20 – Jeff Holt
Photo Credits Vietnam. Can Thu and her 4-year-old daughter Ho Thi Thom
Front Cover – Brent Stirton enjoy activities at a reading and play group supported by
Nepal. Santoshi (right) and Analji (left) learn to write letters in Save the Children.
a preschool class supported by Save the Children in Simalphanta
village. Page 21 – Kate Holt
DR Congo. A young girl carries her family’s mattress on her head
Page 1 – Michael Bisceglie as they flee heavy fighting in Kibati, north of the provincial capital
El Salvador. Lilian reads to her daughters Lilian, 6, and Ana, 4. of Goma.
The books come from a library established by Save the Children.
Page 22 – Peter Caton
Page 2 – Laurence Levin India. This young girl in the Bhagwanpura slum colony in Dhakar
USA. News Commentator Cokie Roberts visits the home of makes money by searching the dump for garbage she can sell.
4-month-old McKenzie who participates in Save the Children’s
Early Steps to School Success program in Owsley County, Page 23 – Michael Bisceglie
Kentucky. Ethiopia. A brother and sister, orphaned by AIDS, at a
therapeutic feeding center. The boy has just finished being treated
for severe malnutrition.

Page 24 – Susan Warner Page 37 – Alfreda Haskie
USA. In Kentwood, Louisiana, Kenyarta and her 2-year-old USA. 2-year-old Jordan and his parents are visited at home
daughter Azireah get regular visits from a Save the Children Early regularly by a coordinator from Save the Children’s Early Steps
Steps coordinator who suggests activities they can do to promote to School Success program on the Navajo Nation in northern
healthy growth and learning. Arizona.
Page 26 – Susan Warner Page 38 – Eileen Burke

USA. 1-year-old Jamayaih and her grandmother enjoy visits from Mozambique. 5-year-old twins Samuel and Pedro lost both
the Save the Children Early Steps coordinator in West Marion, parents to AIDS. They attend a community-based preschool
Mississippi. supported by Save the Children in Guemulene village.
Page 27 – Thomas Boggan, AP/ Wide World Photos Page 39 (left) – Michael Bisceglie
USA. Teenage mothers and their babies take a bus to high school Vietnam. Ho Thi Du works in the field with her 8-month-
in Tempe, Arizona. old baby Ho Thi To. They receive vaccinations and nutritional
counseling through a Save the Children program.
Page 28 – Rick D’Elia
USA. On the San Carlos Apache reservation in Arizona, Page 39 (right) – Mike Kiernan
20-month-old Israel does a puzzle based on primary shapes and Uganda. Young students work on their writing skills in a preschool
colors. The activities are promoted by Save the Children’s Early classroom in conflict-stricken Karamoja.
Steps to School Success program.
Page 40 – Rick D’Elia
Page 30 – Christopher Grant AP/ Wide World Photos Armenia. Teacher Gayane reads a story to kindergarten
Sweden. A boy uses a computer to work on an assignment at students.
school.
Page 41 – Michael Bisceglie
Page 31 – Rebecca Janes Malawi. Children enjoy dancing with wooden dumb-bells – one
Mexico. 3-year-old Briccida and her friends play with of the activities provided by an early childhood development
puzzles at an early childhood development center supported by program supported by Save the Children.
Save the Children in Quiriego.
Page 32 – Susan Warner Vietnam. Ho Thi A Roi – eight months pregnant with her first
USA. 4-year-old Evan at a preschool class in Connecticut. child – goes for a prenatal check-up at a community health center
supported by Save the Children.
Afghanistan. Qand, a 17-month-old girl, plays with string Page 44 – Anna Kari
and wooden beads at an early childhood development center Sierra Leone. Kadiatu’s baby Kadija wears a knit cap that keeps
supported by Save the Children in the village of Ghojar Qudoq. her warm, and could help save her life. “It floods where we live
and it gets very cold when the water comes in the house,” says
Page 35 – Fátima Herrera Kadiatu.
El Salvador. Delfia uses laminated cards to encourage her
18-month-old son Juan to develop good language and motor Page 51 – Bill Foley
skills. Egypt. Amal has a small shop where she sells household items to
make money for her family.
Page 36 – Brent Stirton
Nepal. 4-year-old Anita – who loves going to preschool classes Back Cover – Susan Warner
– is held by her father, Gopal outside their home in Simalphanta USA. 2-year-old Cynthia and her parents are visited at home
village. Behind them are Anita’s mother, Manju, and her 2-year- regularly by a coordinator from Save the Children’s Early Steps to
old brother. School Success program in west Marion, Mississippi.
Worldwide, 75 million children fail to complete primary
school, either because they drop out in the early grades or
because they never got the chance to attend school at all. In
the United States, nearly 2.5 million fourth graders are not
reading at grade level – this is 68 percent of all American
fourth graders.
Children who do not succeed in primary school will have
great difficulty succeeding in life. They are more likely to
experience poverty, ill-health and early childbearing. It will
be harder for them to care well for their own children, and
thus they are likely to perpetuate the cycle of poverty for
another generation.
In contrast, children who succeed in primary school
usually further their education, grow up healthier, postpone
childbirth and become adults with the resources to ensure
their own children’s health and education, thus contributing
to a better future for themselves and their communities.
State of the World’s Mothers 2009 looks at early childhood
development as a proven investment in economic prosperity
and social development. It presents two first-ever indexes,
ranking 100 developing countries and 50 U.S. states based
on how well prepared their youngest children are to succeed
in school.
This report also contains an Early Childhood Development
Report Card looking at the quality of child care in 25 wealthy
countries. It evaluates how well governments are doing in
ensuring that children’s earliest experiences are in the best
interest of both the children’s and their nations’ future.
As in previous years, State of the World’s Mothers 2009
presents a Mothers’ Index. Using the latest data on health,
nutrition, education and political participation, the Index
ranks 158 countries – both in the industrialized and
developing world – to show where mothers fare best and
where they face the greatest hardships.
54 Wilton Road
Westport, Connecticut 06880
1.800.728.3843
Save the Children is the leading independent organization creating

lasting change for children in need in the United States and around
the world. Save the Children USA is a member of the International
Save the Children Alliance, a global network of 27 independent
Save the Children organizations working to ensure the well-being
and protection of children in more than 120 countries.
To learn more about our programs to help children in need
around the world, go to: www.savethechildren.org

State of The World's Mothers 2009: Investing in The Early Years, May 2009

Uploaded by

Copyright:

Available Formats

State of The World's Mothers 2009: Investing in The Early Years, May 2009

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

State of The World's Mothers 2009: Investing in The Early Years, May 2009

Uploaded by

Copyright:

Available Formats

State of the world’s mothers 2009

Investing in the Early Years

2 Foreword by Cokie Roberts

2 | State of the World’s Mothers 2009

In commemoration of Mother’s Day, Save the Children is publishing its tenth annual

State of the World’s Mothers report. Focusing on the critical importance of children’s experiences in

education challenges are affordable – even in the poorest communities.

Save the children | 1

McKenzie is headed in the right direction. Her mom,

2 | State of the World’s Mothers 2009

examines those states and countries that are succeeding

Save the children | 3

• NEPAL Save the children | 5

3) Compared to other wealthy countries, the Recommendations

6 | State of the World’s Mothers 2009

Save the Children’s tenth annual Mothers’ Index

Save the children | 7

Poor cognitive, motor,

• philippines Save the children | 9

10 · Name things the baby hears and sees

10 | State of the World’s Mothers 2009

motor skill development.11 Humans are the “thinking animal,”

with school readiness skills

motor skills and emotional maturity.14

A mother’s level of education greatly influences how well her

Save the children | 11

Research from around the world consistently shows that

• nepal Save the children | 13

eventually yield a “profit” to society. “A publicly financed,

said Heckman. “They raise earnings and promote social 0 20 40 60 80 100

14 | State of the World’s Mothers 2009

Save the children | 15

• mozambique Save the children | 17

18 | State of the World’s Mothers 2009

Save the children | 19

Healthier Children Do Better

300 Under-5 mortality rate 120

Percentage of children who complete • vietnam

Where do young children face the

does not even survive to age 5, and those who do make it

20 | State of the World’s Mothers 2009

In addition to Afghanistan, several other South Asian

Save the children | 21

Where are the most children out of school?

Greatest Number of Children Greatest Share of Children

Out-of-school children, Out-of-school children,

1 Nigeria 8,097 1 Liberia 69%

22 | State of the World’s Mothers 2009

AIDS and Early Childhood

Save the children | 23

• Louisiana Save the children | 25

Greater Needs for Young Children

A recent study found many of the lowest-ranked

26 | State of the World’s Mothers 2009

Save the children | 27

In the United States – like everywhere in the world

Few Hispanic Children Are Ready for School

30 Recognize all letters

28 | State of the World’s Mothers 2009