Child well-being in Eastern Europe and Central Asia: old and new challenges Leonardo Menchini, email: [email protected] Parramatta, 5 November 2009 UNICEF research on the living conditions of children in Central and Eastern Europe and the Commonwealth of Independent States. The MONEE project and the TransMONEE database (1992-2009 at UNCEF IRC, and from 2009 at the UNICEF Regional Office for CEE/CIS) - yearly updated database (with over 150 data tables, with statistics for 27 countries, covering 10 domains) - country analytical reports on specific child topic, development of indicators, work with the statistical office - comparative research on child poverty, child well-being and social policies (Regional Monitoring Reports 1993-2001, Innocenti Social

Monitors 2002-2009, TransMONEE features, Innocenti Insights etc.) 2 Recent UNICEF research and data initiative on children in CEE CIS UNICEF IRC Innocenti Social Monitor 2006 Understanding Child Poverty in SouthEastern Europe and the CIS (mainly based on elaboration of survey microdata) Innocenti Social Monitor 2009 Child Well-being at a Crossroads: evolving challenges in CEE and CIS UNICEF Regional Office for CEE CIS Child poverty studies, with different specific focuses (the most recent ones on the frame of the UNICEF study on child poverty) Cornia (2007) cluster analysis, Richardson, Branshaw, Hoelscher (2008) child wellbeing index, 7 dimensions. Multiple Indicators Cluster Survey III (in 13 CEE CIS countries) 3

Visibility of children in the social and economic policy debate in CEE and CIS. How much children benefited of ten years of continuous economic growth? Aims of the last two editions of the Social Monitor Child poverty and child well-being: proposal of a multi-dimensional approach, linkage with policy. National averages and subnational inequalities comparative analysis, data from household surveys (HBS, MICS, DHS, LSMS, EU SILC), OECD PISA, administrative statistics (MONEE) databases: World Bank, WHO Global Database Child Growth and Malnutrition, WHO mortality database, Eurostat, 4 The context (chapters 2 and 3 of the Social Monitor 2009) Economic growth, one of the fast growing regions in 1999-2007, one

most hit by the global crisis, growth heavily dependent on external factors, concentration of benefits (sectoral, regionals) Inequality (remains at high levels in CIS, continued to grow but from lower levels in Central Europe, low effectiveness of fiscal policy in reducing inequality) Demographic change (ageing population, growth of dependency ratios accelerating from 2010 in CEE and Western CIS, in Central Asia fertility remains above replacement levels, dependency ratios are declining) Public expenditure (low levels in the poorest countries, lack of fiscal space, low investment in health, private expenditure, low effectiveness of social protection expenditure 5 Child well-being at a crossroads 5 dimensions of child well-being 1 Income poverty 2 Health and nutrition

3 Education 4 Housing 5 Parental up-bringing The selected statistics includes outcome (e.g. poverty, nutrition), input (e.g. coverage of immunization) and process (e.g. school enrollment) indicators Comparison of 28 countries, possibly two points in time 2000 and 2005-07, looking at disaggregated data, summaries by sub regions 6 Extreme child poverty /1 Despite 10 years of continuos growth, trends of reduction in child extreme poverty (less than PPP $ 2.50 a day) were not continuous and regular.

Differences among low poverty and high poverty countries remained almost unchanged. Poverty reduction is due to the impact of growth on wages and incomes and - to lower extent on job creation. Cash assistance measures and redistributive policies had only very limited effects. 7 Extreme child poverty /2 Around 2005, extreme child poverty

ranges between 90% of the total child population in Kyrgyzstan, Uzbekistan and Tajikistan, to levels under 2% in some Central European countries and in Croatia. Bulgaria and Romania are the only two EU countries with extreme poverty levels higher than 10%. There, poverty is massively concentrated among Roma children. Roma children received less benefits from the period of growth, and the distance with the rest of the child population actually increased. Higher child poverty rates are registered in rural areas and, especially in CIS, in secondary cities.

8 Extreme child poverty /3 In all countries, extreme child poverty rates are substantially higher than poverty rates for the overall population. The gap between children and the other age-groups is larger in the countries with intermediate levels of poverty. Large families with children are at greater risk of extreme poverty. Social transfers have very small effects in reducing child poverty. During the period of economic recovery and growth, in a context of general poverty reduction, poverty became more

concentrated in the child population: this means that children as a whole benefited less of the period of growth than other population groups. 9 Vulnerability to extreme poverty Growth contributed to improve average living standards in all CEE/CIS countries. The contribution in reducing extreme child poverty varied across the region. Substantial shares of the population were lifted out of poverty, but most of them remained vulnerable (with per capita consumption levels between PPP $ 2.5 and PPP $ 5 a day).

Levels of child vulnerability are very high in some countries of Caucasus and South-Eastern Europe, but are substantial also in Central Europe and the Baltic states. The economic crisis has clearly the potential to transform this vulnerability in actual extreme poverty. 10 Relative income poverty among children in the new EU member states. Statistics on relative poverty among children in CEE confirm that large families with children receive less

benefit from the period of growth. In Poland, Lithuania, Romania and Hungary the relative position of children compared with the average of the population did not improve (and in some cases deteriorated) between 2000 and 2007 11 The health dimension of child well-being. Under-5 mortality/1 Important improvements in child mortality reduction were registered between 2000 and 2007, in particular in

Central Asia (where serious monitoring challenges persist). Despite the improvements, Central Asia continues to register, by far, the highest levels of under-5 mortality, with important inequalities between urban and rural areas and according to family affluence. Addressing inequalities and improving health interventions are among the policy priority for reducing under-5 mortality. 12 The health dimension of child well-being. Under-5 mortality/2 Most of the countries of South-Eastern

Europe have levels of Under-5 mortality, between 10 and 20 per thousand live births: subnational inequalities are substantial and Roma children face a greater risk of dying before their 5th birthday. In the FYR of Macedonia, the Under-5 mortality in rural areas is more than twotimes the one registered in urban areas: inequalities contributed to the stagnation in progress observed in 2000-07 Important success in reducing mortality, in Central Europe, where survival chances of pre-term and low birth weight children improved substantially. 13 The health dimension of child well-being. Nutrition

Improvements in child nutrition were common in the region during the phase of economic growth, and chronic malnutrition remain a matter of public health concern only in Tajikistan. But national averages mask different degree of vulnerability at subnational levels. In Azerbaijan chronic malnutrition rates for children 0-59 months are around 50% in two districts. Important inequalities exist by socioeconomic status of the families. Micronutrients malnutrition reach important levels in some countries of Central Asia, Caucasus and SouthEastern Europe. 14

The health dimension of child well-being. Births attended by skilled healthcare personnel, immunization and breastfeeding Key intervention to reduce mortality and morbidity and to improve child health On average levels of birth attended by skilled personnel and of immunization are high. But in some countries, for some years, there were signs of discontinuity, problems with reaching all children and unequal quality of the service. Exclusive breastfeeding for the first 4-6 months of the life of the child is not common in the region (the highest level is registered in the Republic of Moldova with 45%, most of the countries have levels lower than 30%) 15 The health dimension of child well-being. High levels of

adolescent mortality Less data are available to analyse the health dimension for adolescent. The region, in particular the Former Soviet Union countries report very high levels of adolescent mortality, mainly due to external causes (Russia, Kazakhstan and Lithuania have among the highest levels of male adolescent suicide in the world) 16 The education dimension of child well-being. Early Childhood education Most countries registered important recoveries in the pre-primary enrollments

during the period of economic growth. The majority reached the pre-transition levels of enrollment. Preschool attendance is less widespread in South-Eastern Europe and in particular in Central Asia. Important differences exist between urban and rural areas and between different socio-economic status. Lack of infrastructure, lower demand and perceived low quality (as well as high costs) are among the factors keeping attendance low in some countries. 17

The education dimension of child well-being. Primary and secondary education While for primary education, enrollment is almost universal in all countries of CEE/CIS (few are the exception in the poorest parts of the region, in particular concerning actual attendance), differences exist for upper secondary enrollments. In Central Europe, upper secondary education enrollments are almost universal; the lower rates are registered in Central Asia. Quality of education varies largely between and within countries. School performances (see table) are comparable with those of OECD countries for Central Europe; in the other countries performances are lower,

while inequalities among children are quite high. 18 Extreme housing deprivation among children in CEE/CIS The most extreme form of housing deprivation in CEE/CIS are difficult to monitor. They include the high rates of IDPs in some countries of the region (despite progress in recent years) for example in Azerbaijan, Serbia and BiH. Roma in Eastern Europe and the Balkans are among those most at risk for housing deprivation. Other forms of extreme deprivation are common and linked with the lack of

infrastructure, in particular in rural areas but also for the poorest urban dweller (lack of piped water, use of dirty fuels for heating and cooking). Overcrowding and bad housing conditions are equally widespread also in urban areas. 19 Family up-bringing. Children deprived of parental care The economic crisis at the beginning of the 1990s had an important impact on family formation and family stability in many countries of the region. Placement of children in institution increase with the transition crisis, in particular in Western CIS, Baltic states and Central Europe, but did not show sign of decrease

for most of the recovery period (only around 2005-6). Alternatives to institutionalization are slow to emerge. The number of children in formal care (institutions and foster & guardian care) remains high in several countries of the region. Preventive measures (including support to family) are receiving enough policy priority. 20 Large variety of challenges for improving child well-being in CEE/CIS /1 Richer countries, as seen for adolescent mortality or deprivation of parental up-bringing, do not necessarily fare better Deprivation in some domains (income poverty,

infant mortality, undernutrition, housing etc.) is strongly connected with the low level of GDP, low social expenditure and underdevelopment of the social and economic infrastructure. 21 Large variety of challenges for improving child well-being in CEE/CIS /2 Looking only at average indicators risks to compromise the understanding of the open challenges for improving child well-being (and as consequence the effectiveness of policy responses). Even in countries with lower levels of extreme poverty, better survival chances for new born, better nutrition etc., there are groups in the child population which are far from the common living standards of the society where they live. It is the case, for example, of many children living in rural areas or in economically disadvantaged areas,

children belonging to the Roma minority etc. In many cases, inequalities in nutritional status, access to basic services, in access to decent housing are a direct reflection of the socio-economic background of the household. 22 Large variety of challenges for improving child well-being in CEE/CIS /3 Western CIS and Baltics states (middle to high, in the GDP regional ranking) reports very high levels of adolescent mortality, among the highest in the world in particular for males and with a net prevalence of external causes of death (voluntary and involuntary injuries) Western CIS, Baltic states, some Eastern European countries, as well as Romania continue to have very high numbers of children under the care of the state (institutions, guardianship, foster care). Young people, in all countries but in particular in Central Europe, have in general more difficulties to enter the labour market. Most of South-Eastern European countries (even if at a lesser extent of Caucasus and

Central Asia) report levels of preschool enrollment rates at 50% or lower Quality of education is mixed within countries in the region. Quite high levels of inequality in school achievement s are registered in international comparative assessments 23 Looking at the most vulnerable Chapter 4 of the Innocenti Social Monitor Roma children in Central and South Eastern Europe Children left behind by migrant parents the transition generation, young people in transition from childhood to adulthood (school, labour market, family formation, health and risk behaviours) Investing in Early Childhood Development and Care service

24 Monitoring challenges (Ch. 5 ISM 09) Quality of demographic data (in particular monitoring migrations) Issues related with definitions, definition of indicators, underregistration (e.g. low reliability of mortality data in Central Asia) Definition of child protection indicators Education indicators Access to data Participation of the CEE/CIS countries to international comparative data initiatives Role of MICS, TransMONEE. New directions 25

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