Chapter 7
Women and Children in Poverty

Women are poorer than men because they are often denied equal rights and opportunities, lack access to assets, and do not have the same entitlements as men. They also carry the burden of reproductive and care work and represent the majority of unpaid labour.

—United Nations Development Program, Gender and Poverty Reduction

The quality of a child's life depends on decisions made every day in households, communities and in the halls of government…. As children go, so go nations. It's that simple.

—UNICEF Executive Director Carol Bellamy

Virtually all groups that study poverty—from international organizations like the United Nations and the World Bank to small local charities—agree that the most effective way to reduce it is to improve the social, economic, and political situation of women and, by extension, children. Women's levels of health, education, and security reflect those of their families. When a mother suffers the effects of poverty, future generations of her family do as well, creating a cycle of impoverishment from which it is very difficult to escape.

GLOBAL CONVENTIONS ON THE RIGHTS OF WOMEN AND CHILDREN

UN Convention on the Rights of the Child, 1989

In 1989 the United Nations (UN) adopted a treaty called the Convention on the Rights of the Child (CRC). Considered one of the most wide-ranging and important human rights documents the global community had ever agreed upon, the CRC was charged with establishing "norms" and standards for the lives of children to which all countries could hold themselves accountable, including:

• Protection from violence, abuse, and abduction
• Protection from hazardous employment and exploitation
• Adequate nutrition
• Free compulsory primary education
• Adequate health care
• Equal treatment regardless of gender, race, or cultural background

The CRC became the most widely ratified human rights treaty in history, passed by 192 countries. As of 2006 only two countries had not ratified it: Somalia and the United States. (Ratification by the United States was hampered by the fact that the Convention forbids capital punishment of minors. Before the U.S. Supreme Court outlawed it in Roper v. Simmons (2005), several states had allowed the death penalty for those who were between sixteen years old and eighteen years old at the time they committed their crimes.)

Beijing Declaration and Platform for Action, 1995

In September 1995 at the United Nations Fourth World Conference on Women in Beijing, China, representatives of 189 countries unanimously adopted a program intended to promote gender equality around the world, which became known as the Beijing Declaration and Platform for Action. One of the main goals outlined by the Platform was addressing the enormous increase of women living in poverty in the late twentieth century—a trend that has come to be known as the "feminization of poverty." The Platform sought to:

• Review, adopt, and maintain macroeconomic policies and development strategies that address the needs and efforts of women in poverty
• Revise laws and administrative practices in order to ensure women's equal rights and access to economic resources
• Provide women with access to savings and credit mechanisms and institutions
• Develop gender-based methodologies and conduct research to address the feminization of poverty

UN Millennium Development Goals and Other Conventions

In 2000 all member countries of the United Nations pledged to meet eight human development goals outlined in the Millennium Campaign, an international effort to eradicate extreme poverty, along with its causes and consequences. These Millennium Development Goals (MDGs) include four that specifically address the needs and challenges of women and children affected by poverty:

• Achieve universal primary education
• Promote gender equality and empower women
• Reduce child mortality
• Improve maternal health

The standards of the CRC, the Beijing Platform, and the Millennium Campaign together have led to a global acknowledgment that the protection of children and the eradication of gender disparities are essential to combating poverty. Figure 7.1 shows how many countries have ratified the Convention on the Rights of the Child, the Convention on the Elimination of All Forms of Discrimination against Women (1979), and the International Convention on the Worst Forms of Child Labour (1999). Also included is information on the Optional Protocols to the Convention on the Rights of the Child on child prostitution and pornography (2000) and on the involvement of children in armed conflict (2000).

PROGRESS TOWARD INTERNATIONAL GOALS

Progress has been made toward many of the development goals outlined by the UN during the 1990s. According to the UNDP (http://hdr.undp.org/reports/global/2005/pdf/presskit/HDR05_PR1E.pdf), since the 1990s more than 135 million people have been lifted out of extreme poverty (having an income of less that one dollar per day per person), 1.2 billion people have gained access to clean water, thirty million more children attend school, and child deaths have been reduced by two million per year. However, as of 2005, 2.5 billion people stilled lived on an income less than two dollars per person per day, more than one billion people still did not have access to safe water, 115 million children were still not in school, and more than ten million children per year still died of preventable causes.

Beijing+10

In March 2005 during a conference in New York City that became known as Beijing+10, the UN Commission on the Status of Women assessed progress toward the goals outlined in the Beijing Platform (http://daccessdds.un.org/doc/UNDOC/GEN/N04/636/83/PDF/N0463683.pdf?OpenElement). According to the report, as of 2004 women were more likely than men to be poor, and female-headed households were more likely than male-headed households to be poor. Among the statistics cited by the UN, in Malawi a full three-quarters of the poor are women; in Zimbabwe, 72% of female-headed households are poor, compared with 58% of households headed by men. Even in the developed world women fared worse than men; according to the UN report, for instance, women headed 62% of poor households in the Netherlands. Only Burkina Faso reported that men experienced higher poverty rates: 46.9% of households headed by men experienced poverty in that west African country, compared with 36.5% of households headed by women.

Many of the national programs begun since the Beijing Platform focus on increasing women's employment opportunities, ensuring social safety nets, and improving training and education. Some countries instituted minimum wage laws, affecting the poor women who make up the majority of low-income workers. In Portugal, for example, 69% of the people who benefited from the country's minimum wage in 2003 were poor women, according to the UN report. Other countries created lines of credit, loans, and other incentives for self-employment and entrepreneurship. In 2002 Vietnam's program granted loans to more than 20% of poor households headed by women. Some developing countries—including Liberia, Namibia, Zimbabwe, and the Dominican Republic—have changed their laws on inheritance and land ownership to include women.

INFORMAL LABOR

However, implementation of programs consistent with the goals of the Beijing Platform has not been uniform throughout the world. In Beijing Betrayed: Women Worldwide Report That Governments Have Failed to Turn the Platform into Action (Women's Environment and Development Organization [WEDO], March 2005, http://www.wedo.org/files/beijingbetrayed.htm), organizations from 150 countries reported on actions taken—or not taken—since 1995.

One of the trends cited by WEDO as having a significant impact on women in poverty is the proliferation of informal paid labor, or work that is outside the formal labor sector and therefore not subject to legal protections such as safety and wage regulations. The WEDO report estimates that at least 60% of women in developing countries are employed in the informal work sector, although precise figures are impossible to obtain because this type of work falls outside government purview. In Figure 7.2 the three pyramids represent the top-to-bottom structure of informal work and poverty according to gender. Employers—the highest paid people in the informal sector—are overwhelmingly male, while those working exclusively in the informal sector and those performing industrial outwork—overwhelmingly female sectors—have the highest risk of living in poverty.

TABLE 7.1

Costs of informal work

Direct costs

1. High costs of running informal businesses, including direct and indirect taxes
2. High costs of informal wage work
   • Long hours and unscheduled overtime
   • Occupational health hazards
3. High costs of accessing capital in informal financial markets and high indebtedness
4. High costs associated with periodic 'shocks' to work

Indirect costs

1. Lack of secure work and income
   • Greater insecurity of work
   • Variability and volatility of income
2. Lack of worker benefits and social protection
   • Few (if any) rights such as paid sick leave, overtime compensation or severance pay
   • No childcare provisions
   • Little (if any) employment-based social protection
   • No health, disability, property, unemployment or life insurance
3. Lack of training and career prospects
4. Lack of capital and other assets
   • Lack of/vulnerability of productive assets
   • Limited (if any) access to formal financial services
5. Lack of legal status, organization and voice
   • Uncertain legal status
   • Lack of organization and voice

source: Martha Chen, Joann Vanek, Francie Lund, James Heintz, with Renana Jhabvala, and Christine Bonner, "Box 4.1. Costs of Informal Work," in Progress of the World's Women 2005: Women, Work, and Poverty, United Nations Development Fund for Women, 2005, http://www.unifem.org/attachments/products/PoWW2005_eng.pdf (accessed April 8, 2006)

Table 7.1 lists the direct and indirect costs involved in working in the informal sector. Of particular concern to women are the indirect costs related to a lack of child care, health benefits, sick leave, and insurance. With women largely responsible for the care of children and the home, the daily insecurity of having no options for child and health care or time off to care for an ill family member, along with the longer-term problem of having no disability or employment insurance, makes working in the informal economy an extremely difficult task.

POLITICAL REPRESENTATION

Another global issue highlighted by the Beijing Platform is the lack of female representation in governments and public administration. One of the specific goals of the Platform was to increase the proportion of women serving in national parliaments around the world to 30%. In some countries positive results have been realized: in Rwanda gender quotas led to women comprising 48.8% of the national parliament in 2005. That same year 36% of members of the Cuban parliament were female, and in South Africa 32.8% were female. Still, twelve countries had no female representatives: Bahrain, Kuwait, Micronesia, Nauru, Palau, Saint Kitts and Nevis, Saudi Arabia, Solomon Islands, Tonga, Tuvalu, United Arab Emirates, and Guinea-Bissau. Even in the United States, where women outnumber men in the population 51% to 49%, representation is not equal: women made up only 15.1% of the U.S. Congress in 2006.

In 2005 the African country of Liberia ushered in what international observers believe could be the beginning of change for the entire continent and for the developing world overall, electing Africa's first female president, Ellen Johnson-Sirleaf, a Harvard-educated economist who once headed the United Nations Development Program and advised the World Bank. Chile also elected its first female president, Michelle Bachelet, in 2006, beginning a new era of government in Latin America. With women gaining positions of power and influence, legislation that addresses female poverty should have a better chance of ratification.

The Millennium Development Goals: Five Years Later

In 2005 the United Nations published a five-year review of movement toward the MDGs (http://millenniumindicators.un.org/unsd/mi/pdf/MDG%20Book.pdf). While the UN report found progress, it conceded that the goals are not on track to be fulfilled by the 2015 deadline. For example, the goal to halve extreme poverty between 1990 and 2015 is off track, even though poverty overall has been reduced in most regions. More than 800 million people in developing countries suffer from chronic hunger—an increase since 1990—and about a quarter of children younger than five in the developing world are malnourished. Of the estimated eleven million children who die each year from treatable causes, more than half die as a direct result of malnourishment and disease. Figure 7.3 shows how achievement of the MDGs would improve children's lives. Among children under five years old, 5.5 million lives would be saved in 2015 alone.

Between 1990–91 and 2001–02, enrollment in primary school in developing regions overall increased from 80% to 83%. In five regions—Latin America and the Caribbean (LAC), East Asia, Central Asia, Northern Africa, and Southeast Asia—enrollment reached greater than 90%. While this level of enrollment is considered an impressive advance, the MDG of achieving universal primary school enrollment is moving slowly. More than a third of school-age children in sub-Saharan Africa do not attend school. In South Asia, West Asia, and the Pacific Rim countries, 20% of children do not attend school.

Progress toward the MDGs that specifically address women's issues has been disappointing. The UN's MDG report found that women by far outnumber men in the informal workforce, both paid and unpaid; 62% of unpaid family workers are women. The UN also reported that maternal mortality rates are not dropping in the countries where pregnancy and childbirth are already the most dangerous. While in the developed world the rate was fourteen maternal deaths per 100,000 live births in 2000, in developing regions the rate was 450 deaths per 100,000 live births. At the same time in sub-Saharan Africa, the rate was 920 deaths per 100,000 live births—by far the highest rate in the world. On the other hand, there have been a few significant advances in the goal of improving health services for pregnant women and new mothers. For instance, the proportion of deliveries in the developing world attended by skilled professionals increased from 41% in 1990 to 57% in 2003.

THE FEMINIZATION OF POVERTY

The term the "feminization of poverty" was first used in 1978 by a researcher named Diana Pearce, who had found that two-thirds of poor adults over age sixteen in the United States were female. Although Pearce was referring specifically to U.S. data, the term entered common usage in both poverty research and women's studies. The feminization of poverty is generally understood to have three main causes:

• The increasing number of female-headed households
• Individual and cultural stereotypes about and discrimination against women and girls
• Macroeconomic trends such as globalization and trade that fail to take into account women's roles in economies

There are many reasons women tend to be poorer than men. Lower wages, failed social safety nets, fewer educational opportunities, substandard health care, and a lack of employee protections and benefits such as paid maternity leave and child care all contribute to the problem. In addition, women typically are the primary caretakers of children and elders, which also makes them more vulnerable to impoverishment as they have less time to earn money outside the home.

Women's Work

The United Nations Development Fund for Women (UNIFEM) explains in its report Progress of the World's Women 2005: Women, Work, and Poverty that, although globalization has brought new opportunities for highly educated and skilled workers, it has in many cases had the opposite effect on those with less training and education, who typically come from poor backgrounds in the first place. According to the UNIFEM report:

Increasingly, rather than informal work becoming formalized as economies grow, work is moving from formal to informal, from regulated to unregulated, and workers lose job security as well as medical and other benefits. What we are seeing is that growth does not automatically "trickle down" to the poor. It can in fact widen the gap between rich and poor. As globalization intensifies, the likelihood of obtaining formal employment is decreasing in many places, with "footloose" companies shifting production from one unregulated zone to an even less regulated one elsewhere, employing workers in informal contract or casual work with low earnings and little or no benefits.

This situation has become common in developing countries, where 50% to 80% of nonagricultural employment is in the informal sector. More than 60% of women in developing countries perform nonagricultural paid informal labor; the figure rises when informal paid agricultural work is factored in. Additionally, many women perform informal unpaid agricultural work on family or community farms. Average wages are lower for both informal and agricultural workers, male and female, and the risk of falling into or remaining in poverty is higher for those workers as well.

In addition to earning lower wages and having a greater risk of poverty, workers in the informal sector are at a higher risk of experiencing human rights abuses, including a lack of access to social services and basic infrastructure (passable roads, clean water, reliable sanitation, etc.); a greater chance of becoming ill or disabled and of losing property; fewer work-related benefits and securities; fewer housing and property rights; and generally worse health, less education, and shorter life spans. Some specific risks for garment workers, street vendors, and waste pickers are outlined in Table 7.2.

TABLE 7.2

Occupational health and safety hazards

Problems associated with poor health and safety in the workplace vary from job to job and are also heavily dependent on the environment in which each job is undertaken Some of the common problems associated with different types of informal work include

1. Garment makers
   • Neck and backache
   • Pain in limbs and joints
   • Poor vision resulting from eye strain
   • Headaches, dizziness and fatigue
   • Respiratory problems associated with dust and textile fibres
2. Street vendors
   • Exposure to weather—extreme temperatures, wind, rain and sun
   • Poor access to clean water
   • Poor sanitation from dirty streets and poor drainage, as well as waste produce from other vendors
   • Diseases transmitted by vermin
   • Lead poisoning and respiratory problems from vehicle fumes
   • Musculoskeletal problems associated with ergonomic hazards at workstations and static postures
   • Risk of physical harm from municipal authorities, members of the public or other traders
3. Waste pickers
   • Exposure to weather—extreme temperatures, wind, rain and sun
   • Poor sanitation and limited or no access to clean water
   • Exposure to dangerous domestic and industrial waste, including toxic substances such as lead and asbestos
   • Exposure to other dangerous matter, including blood, faecal matter, broken glass needles, sharp metal objects and animal carcasses
   • Back and limb pain, itchy skin/rashes
   • Diseases transmitted by vermin, flies and mosquitoes
   • Specific high risk of tuberculosis, bronchitis, asthma, pneumonia, dysentery and parasites

source: Martha Chen, Joann Vanek, Francie Lund, James Heintz, with Renana Jhabvala, and Christine Bonner, "Box 4.2. Occupational Health and Safety Hazards," in Progress of the World's Women 2005: Women, Work, and Poverty, United Nations Development Fund for Women, 2005, http://www.unifem.org/attachments/products/PoWW2005_eng.pdf (accessed April 8, 2006)

Female workers are at a higher risk of poverty not only because average wages are lower for women than for men (see Table 7.3; "own account" workers are those who produce goods for their own use; "private wage" earners are those working in the private sector; "public wage" earners work in the public sector; "domestic" earners work in cleaning, cooking, child care, etc.) but also because women tend to work fewer hours due to their unpaid responsibilities in the home and community. These responsibilities—which include the care of children, elderly, and sick family members; domestic chores such as cooking, cleaning, making clothing, and growing food; and unpaid work in the community—are referred to as "unpaid care work." This designation helps to distinguish it from paid domestic labor (formal or informal), such as cooking, cleaning, and/or child care in other people's homes or businesses.

UNIFEM identifies four "dimensions" that create the relationship between work—paid and unpaid—and poverty for women:

• The temporal dimension: Because women spend more time doing unpaid work within the home, performing housework and child care, they have less time to spend doing paid work outside the home, although studies have shown that, overall, women spend more time working overall than men do. This means that women tend to do more part-time paid work, which in turn means that they earn less money. In developing countries women spend much of their unpaid time performing heavier physical chores such as collecting water and fuel and growing and harvesting crops, leaving them even less time for paid work as well as for child care.
• The spatial dimension: Women in both developing and developed countries sometimes are forced to migrate to other areas, regions, or even countries to find paid work. This might mean leaving a rural home to work in a city (or vice versa) or migrating from, for example, a country like Mexico to perform seasonal farm work in a country like the United States. In either case, a woman who migrates for work will have to find someone to care for her family while she is away. At the same time, however, women who have children often are not able to migrate to regions with better work opportunities.
• The employment segmentation dimension: Women's traditional role as caretakers within the home has led to a narrow choice of work outside the home. Without specific training or education, women in almost every culture tend to fall into the same occupations: domestic servants, clothing and textile workers, teachers, and care workers. These occupations tend to be relatively unstable, informal, lower-paying, and, in some cases (such as in the textile industry), more dangerous than other jobs.
• The valuation dimension: The value placed on work that is seen as traditionally female is related to employment segmentation. "Women's work," meaning the kind of work that women typically do for free within their homes and communities, generally is considered less valuable than work that is perceived to require more training or education. Therefore, it is less regulated and brings in lower pay.

Gender is not the only factor that determines women's greater likelihood of impoverishment and

difficulty obtaining and holding on to work. In different cultures religion, race, and especially class play a role. However, as the dimensions of work described above demonstrate, women in general—in nearly every culture—experience living and working conditions that make economic advancement difficult.

Poor women who do work typically find employment in more or less undesirable jobs. Some are degrading; others are dangerous. Some cause health problems, while others are simply monotonous. Women living in extreme poverty tend to fall into the same types of work regardless of where they live in the world: begging, digging for garbage, sweatshop labor, farm work, street vending, and prostitution—voluntary and forced—are some of the most common types of employment for poor women.

Women's Wages and Poverty Rates in the Developed World

According to the Women's Learning Partnership for Rights, Development, and Peace (WLP), a nongovernmental organization (NGO) that works as a consultant group to the United Nations, in every country in the world women's pay is lower than men's, including countries in the developed world. Globally speaking, women earn an average of 30% to 40% of what men earn. Living in a developed country does not guarantee a working woman equity in wages: the WLP reports that in France, Germany, Italy, and the United Kingdom, women earn an average of 75% of what men earn, while in Australia, Sri Lanka, Tanzania, and Vietnam women's wages are 90% of men's.

THE UNITED STATES

Median weekly full-time earnings of American women in 2004 were about 80% of the earnings of men (Bureau of Labor Statistics, Women in the Labor Force: A Databook, May 2005). This is in spite of the Equal Pay Act of 1963 (EPA), which outlawed unequal pay for equal work. (American women at that time had median earnings equal to fifty-eight cents for every dollar earned by American men.) The National Women's Law Center reports that as of 2004 African-American women in the United States had median earnings of sixty-five cents for every dollar earned by white men, and Hispanic women earned just fifty-six cents for every dollar earned by white men (http://www.nwlc.org/pdf/PaycheckFairnessActApr06.pdf).

Among U.S. workers active in the labor force for at least twenty-seven weeks during 2004, a slightly higher percentage of women (6.2%) than men (5%) lived in poverty (Bureau of Labor Statistics, A Profile of the Working Poor, 2004, May 2006). However, for working families (those with at least one family member in the labor force for half the year or more), the rates displayed a wider gap, with families headed by single women (22.6%) experiencing a significantly higher poverty rate than families headed by single men (13.2%).

According to a joint report by the AFL-CIO (American Federation of Labor-Congress of Industrial Organizations) and the Institute for Women's Policy Research ("Equal Pay for Working Families: National and State Data on Pay Gap and Its Costs," 1999), closing the wage gap between the sexes would increase women's total family income by $4,000 a year and could cut poverty rates in half.

CANADA

According to the Canadian Research Institute for the Advancement of Women (CRIAW), as of 2005 one in seven Canadian women (2.4 million in total) was living in poverty, and women working full-time, year-round earned just 71% of what men earned ("Women in Poverty," 2005 http://www.criaw-icref.ca/). In fact, Canada, which is one of the wealthiest countries in the world, had the fifth-largest wage gap in the developed world in 2004, after Japan, Korea, Portugal, and Spain (OECD in Figures, 2004). Statistics Canada reports that as of 2001 (the most recent figures available at the time of publication) the average income of women with a post-secondary degree was Can$29,539; average income for men with less than a ninth-grade education was Can$30,731, indicating that higher levels of education do not necessarily lead to higher pay for Canadian women.

Unmarried women under age sixty-five living alone had a poverty incidence of 38.4% in 2004, according to Statistics Canada (http://www40.statcan.ca/l01/cst01/famil41a.htm). Because many of these single women also headed families, children under age eighteen who lived in households headed by a single woman suffered a higher incidence of poverty (52.1%) than children living in two-parent families (11.6%). Average total income in families headed by single women (Can$34,100) was significantly less than in families headed by men alone (Can$52,900) in 2004 (http://www40.statcan.ca/l01/cst01/famil05a.htm). In fact, 37% of single mothers who work make less than Can$10 an hour, according to the CRIAW. "Women in Poverty," also observes that the highest rates of poverty and the lowest wages for women in Canada occur among Aboriginal (Native Canadian), immigrant, minority, and disabled women. The average annual income of Aboriginal women is Can$13,300, compared with Can$19,350 for non-Aboriginal women. Immigrant women who have college degrees earn an average of Can$14,000 less than Canadian-born women with college degrees. Minority women in Canada earn an average of Can$16,621 annually, while disabled women earn about Can$17,000 a year.

THE EUROPEAN UNION

In the European Union (EU) women's earnings averaged about 16% lower than men's, according to the European Commission's (EC) publication The Social Situation in the European Union 2004. This finding was confirmed by the EC's Report from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions on Equality between Women and Men, 2005, which also noted that the gap had closed slightly—to 15%—with the addition of ten more countries to the Union in 2004 (the Czech Republic, Estonia, Cyprus, Latvia, Lithuania, Hungary, Malta, Poland, Slovenia, and Slovakia).

POOR WOMEN'S HEALTH

It is not surprising that poor people suffer from more health problems and receive a lower quality of health care than their nonpoor counterparts. Women, however, suffer disproportionately, first because there simply are more poor women than poor men in the world, and second because, as the bearers of children, women face a different set of potential diseases, illnesses, and injuries related to their reproductive systems.

The Millennium Development Goal of improving maternal health, as opposed to women's health, points to the significance of reproduction in the overall picture of women's health, as well as in the social and economic status of their families. A mother's health typically reflects the health of her entire family, just as a mother's education reflects that of her children (see section below). Of the link between poverty and maternal health, United Nations Population Fund (UNFPA) executive director Thoraya Obaid stated in October 2005: "If women are healthy then they can jump start the life of their family and the economy" ("Women's Health Fuelling Poverty," BBC News, October 12, 2005, http://news.bbc.co.uk/2/hi/health/4331996.stm).

Reproductive Health and Poverty

In State of World Population 2005. The Promise of Equality: Gender Equity, Reproductive Health, and the MDGs the UNFPA cites illnesses of the reproductive system as the leading cause of death and disability of women globally and the second most common cause of poor health in the world after communicable diseases. According to an estimate by the Alan Guttmacher Institute, women's reproductive health issues result in the loss of as much as 250 million years' worth of productive time each year and a 20% reduction of women's overall productivity ("The Benefits of Investing in Sexual and Reproductive Health," Issues in Brief, 2004). The UNFPA reported in 2005 that complications of pregnancy and childbirth kill one woman every minute and injure twenty others—99% of them in developing countries. Figure 7.4 provides a breakdown of the causes of maternal death as reported by the World Health Organization (WHO) in 2005. According to the State of the World Population, several aspects of reproductive health have wide-reaching and long-term socioeconomic effects on families, communities, countries, and even entire regions.

Because most maternal deaths occur in already impoverished countries that are clustered together geographically, their regional impact is particularly acute. At the most personal level, children who lose their mothers tend to experience emotional problems that eventually may make them less productive as adults, and households lose valuable income without an adult female wage earner; many families, in fact, are pushed over the brink of poverty as a result of the

high cost of health care when a mother becomes sick. (See Table 7.4.) Communities feel the loss because women in developing countries perform so many essential unpaid tasks, such as caring for children and elders, growing and harvesting food, and gathering fuel and water. High rates of maternal deaths affect the overall economic situation in a region in terms of lost productivity and lost potential for economic, cultural, and technological expansion.

WHO's World Health Report 2005: Make Every Mother and Child Count warns that if progress on improving maternal health continues at the slow rate it has seen since the 1990s, the Millennium Development Goals will not be met by 2015. Of the 136 million births every year, 529,000 result in the death of the mother; as of 2005, 300 million women were experiencing illnesses brought on by pregnancy or childbirth. WHO maintains that most of those deaths could be prevented with increased access to skilled care during and following childbirth. In 2005, 43% of mothers and newborns received some care at birth, but not enough to prevent the complications that often arise. Additionally, WHO reports that increased public expenditures on health care, higher wages for health care workers, and universal access to medical care are essential to reaching the MDGs, especially those that relate to women and children.

Table 7.5 illustrates the link between reproductive rights and the MDGs. Included in reproductive rights are issues such as violence against women and the rights to marry voluntarily, space children as desired, receive clear and accurate information about the reproductive process, and benefit from scientific progress. For women living in low-income countries, these rights cannot be

taken for granted. In fact, many are prohibited from using contraception—or from even receiving information about it—and must marry whomever their families choose for them. In some cultures, going against these conventions can place the woman in a position that results in physical and emotional violence. The inability to decide how many children to have or how many years apart to have them can easily overwhelm a family's finances, particularly a family that is already poor. There are also health considerations: a woman who can control her reproductive choices is more likely to receive adequate health care, and thus less likely to die in childbirth.

In Poverty Reduction: Does Reproductive Health Matter? (World Bank Health, Nutrition and Population, July 2005), Margaret E. Greene and Thomas Merrick argue that controversy over reproductive rights—namely, abortion and birth control—has hit poor women particularly hard. According to Greene and Merrick, the issue has actually harmed poor women's health: governments have been pressured to cut funding for medical care and family planning, and the United Nations was forced to drop the goal of achieving universal reproductive health care from the Millennium Declaration. The United Nations Population Fund reports in State of the World Population 2005 that as of 2005 the world's women suffered disproportionately from sexual and reproductive health problems—nearly 35% of women globally versus less than 20% of men.

Figure 7.5 shows the percentages of the poorest and wealthiest women who give birth with the attendance of skilled medical personnel in selected low-income countries. Poor women are far less likely to have a skilled attendant present during the births of their children. In Vietnam, where 100% of the richest women have access to medical personnel during childbirth, only 58% of the poorest women do. In Ethiopia just 1% of the poorest women receive medical attendance at childbirth, versus 25% of the wealthiest women. These numbers demonstrate that the world's poorest women do not have reproductive rights equal to those of their nonpoor counterparts.

Lack of family planning options most strongly affects poor young women, who may not be prepared for pregnancy and parenthood physically, emotionally, or financially. Figure 7.6 shows the disparity of contraceptive use among the poorest and richest women in Ghana, Yemen, Guatemala, the Philippines, India, and Kazakhstan. In Guatemala, for example, only 5% of the nation's poorest women use contraceptives compared with 60% of wealthy women. Figure 7.7 compares childbearing among the poorest and richest women under age eighteen in Niger, Nicaragua, Nepal, Tanzania, Kenya, Bolivia, and Turkey. In Niger nearly three-quarters (72%) of poor women had given birth by age eighteen, compared with two-fifths (39%) of wealthy women. In reviewing economic and sociological publications on the link between poverty and early childbearing, Greene and Merrick cite the following points of connection:

• Poor health outcomes for the young mother and her child: higher risk of obstetric complications, leading to higher maternal mortality and morbidity (illness or disease) if she survives; increased risk of abortion and abortion complications if the abortion is unsafe; and low birth weight and other problems for the newborn
• Poor educational outcomes for both the mother and her child, including dropping out of school and less schooling for the child
• Lower and/or altered investment and spending patterns in the mother's immediate and extended family (costs of medical care and child care, for example, can make it difficult or impossible to save money)
• Possibly lower labor force participation by the young mother, with less opportunity to contribute to household income
• Reduced community participation and greater chances of divorce or single parenthood

Early childbearing tends to occur more often in poor countries but even in wealthier countries the highest rates of fertility among adolescents are found among the poorest groups. Greene and Merrick reported that in 2004, for example, out of a sample of fifty-five countries, the average adolescent fertility rate (the number of women who had given birth before age twenty) for the richest group was 62.6 per 100,000 population, versus 148.6 per 100,000 population for the poorest group. The highest regional rates for adolescent poor women were in Latin America and the Caribbean (172.6 births per 100,000 population), followed by sub-Saharan Africa (169.6). The sampled region with the lowest adolescent fertility rate was East Asia, at forty-six births per 100,000, but it is important to note that in that region only four countries were sample, compared with twenty-nine countries in sub-Saharan.

According to Greene and Merrick, studies have shown that poor women of all ages experience more difficulties with pregnancy and childbearing, but adolescent mothers have more extreme problems because their bodies may not be developed enough to sustain the physical challenges of giving birth. In developing countries women aged fifteen to nineteen are twice as likely to die from complications of childbirth than women in their twenties. Women in poor countries tend to marry and begin having children earlier than women in wealthier countries. This is partly the cause of the significantly higher number of maternal deaths in underdeveloped and developing regions. (See Table 7.6.) In fact, as Table 7.6 illustrates, the total number of maternal deaths increased annually from 515,000 in 1995 to 529,000 in 2000. Developing regions overall saw an increase from 512,000 in 1995 to 527,000 in 2000, with Asia experiencing the greatest increase. Figure 7.8 shows the various factors that link early pregnancy with poverty. Factors such as a lack of education, childhood and adult illness and malnutrition, a lack of access to natural resources and involvement in the global economy, and high mortality rates can all be linked to higher fertility rates, which in turn lead to lower per capita income.

OBSTETRIC FISTULA

One of the most serious health and social consequences of childbirth in poor countries—particularly in sub-Saharan Africa and South Asia—is the development of obstetric fistula. This childbirth-related injury is caused by exceptionally long labor, often as long as five to seven days, that cuts off blood flow to the vagina, bladder, and/or rectum. The resulting holes in the tissue leave women unable to control the flow of

urine and feces, which leak out constantly. Nerve damage to the legs, severe infections, and kidney disease are also common among fistula sufferers.

According to the Fistula Foundation (www.fistulafoundation.org/) and the United Nations Population Fund (UNFPA), more than two million women in the developing world are known to suffer from obstetric fistula, which was virtually eradicated in wealthier countries when caesarian sections became commonplace in the late nineteenth century. The actual number of women who live with the condition is believed to be much higher, since it is rarely discussed and most women who suffer from it never get medical help. WHO estimates that in Nigeria alone, for example, as many as 800,000 women have fistulas, with 20,000 more developing the condition every year ("545 Women Operated on during 'Fistula Fortnight,'" March 7, 2005). Globally, obstetric fistula is believed to occur in 50,000 to 100,000 women per year, most of them under the age of twenty.

According to UNFPA's Campaign to End Fistula (www.endfistula.org/):

Poverty, malnutrition, poor health services, early marriage, and gender discrimination are interlinked root causes of obstetric fistula. Poverty is the main social risk factor because it is associated with early marriage and malnutrition and because poverty reduces a woman's chances of getting timely obstetric care.

Obstetric fistula is a cause of poverty among women as well as a consequence. Sufferers are often abandoned by their husbands and families and ostracized by their communities because of the stigma attached to their condition. Many are driven from their homes and left to survive or die on their own. The condition can, however, be repaired with surgery, which has about a 93% cure rate, according to the Fistula Foundation. However, few women in affected regions either know about the surgery, which costs from $100 to $400, or have access to it, and most cannot afford it.

In 2003 the first major report on fistula—Obstetric Fistula Needs Assessment Report: Findings from Nine African Countries—was published jointly by the UNFPA and the nonprofit organization EngenderHealth. Focusing on the countries most affected by obstetric fistula, the report identified seven critical needs of regions with the highest numbers of fistula sufferers, including education about the physical dangers of early marriage and pregnancy, family planning and maternal health; increased medical care in the form of prevention and treatment; social support services to address the physical and psychological needs of fistula sufferers.

EDUCATION: A TOOL TO LIFT WOMEN OUT OF POVERTY

The Beijing Platform declared that education is an essential human right that contributes to economic development at all levels of society—a declaration that has been supported by the UN, UN Educational, Scientific, and Cultural Organization (UNESCO), the World Bank, and most nongovernmental organizations. However, according to the Education for All Global Monitoring Report 2006: Literacy for Life (2005, http://portal.unesco.org/education/en/ev.php-URL_ID1/443283&URL_DO1/4DO_TOPIC&URL_SECTION1/4201.html), at least 771 million adults over the age of fifteen—one-fifth of the world's adult population—cannot read or write at a functional level; at least two-thirds of them are women.

In its State of the World Population 2002: People, Poverty, and Possibilities (2002, http://www.unfpa.org/swp/2002/english/ch1/), the United Nations Population Fund (UNFPA) reports that 31% of women had no formal education in 2000, versus 18% of men. There are many reasons for this disparity, and poverty is chief among them: although women are almost universally less likely to attain high levels of education, being female and poor is, according to the UNFPA report, a "double disadvantage." In rural areas the long walking distances to schools discourage families from sending girls because they fear girls will be sexually assaulted on the way. Fees for attendance, books, and uniforms can also affect whether girls are sent to school. Again, girls in some regions are vulnerable to sexual exploitation from wealthier men who offer to pay for girls' schooling in exchange for sex. Early marriage and pregnancy also cause millions of girls to drop out of school every year. Many families decide to keep daughters at home to help tend and harvest crops, do housework, and care for elders and young siblings. The costs associated with educating girls are generally not seen as worthwhile because girls are not expected to continue their education or earn a living when they grow up. More simply, in many cultures girls are not valued in the same way that boys are, so to many impoverished families educating them seems like a waste of time and money—and in some places it is altogether forbidden.

Barbara Herz and Gene B. Sperling report in What Works in Girls' Education: Evidence and Policies from the Developing World (2004, http://www.cfr.org/content/publications/attachments/Girls_Education_full.pdf) that education for girls in developing countries is essential for economic success at all levels of society. The benefits of educating girls are seen from families to nations, in the forms of higher wages, faster economic growth, and more productive farming. This in turn results in decreased levels of malnutrition; women having smaller, healthier, more educated families; reducing the spread of HIV/AIDS; reducing rates of violence against women; and fostering democratic participation in society.

According to Herz and Sperling, when girls attend school just one year beyond the average, they eventually earn 10% to 20% more than average as adults. On the macroeconomic level, even modest increases in the number of women receiving a secondary education can lead to an increase in annual per capita income of 0.3%; likewise, as per capita growth continues, more girls achieve higher levels of education—a cycle that is beneficial, ultimately, for everyone. Similarly, the more education women have, the lower their rates of fertility will be. In Brazil, for example, illiterate women have an average of six children each, whereas literate women average 2.5 children each. Lower overall fertility rates lead to healthier, better-educated children. In fact, infant mortality rates are between 5% and 10% lower among girls who stay in school just one year longer than average. In countries where girls receive as many years of schooling as boys, infant mortality rates are 25% lower than in countries that do not have educational gender parity (equality).

Herz and Sperling conclude that governments of low-income countries can encourage families to educate their daughters and increase overall educational gender parity by eliminating school fees, providing local schools with flexible schedules that are safe for girls, and focusing on providing a quality education that realistically takes into account the needs of girls and their families.

Table 7.7 shows which countries achieved the Millennium Development Goal of gender parity in education as of 2002, those that are likely to achieve the goal by 2005, those that are likely to achieve the goal by 2015, and those countries that are in danger of not achieving the goal by 2015.

VIOLENCE AGAINST WOMEN

Violence against women happens in every economic class of every culture around the world. While it is a multifaceted social problem, many experts consider it to be largely a health issue because of the physical and emotional havoc it wreaks on its victims; the other dimension of violence against women is that it is a human rights issue. Amnesty International calls it "a major human rights scandal and a public health crisis" ("Women, Violence, and Health," March 2004, http://www.web.amnesty.org/library/Index/ENGACT770012005?open&of1/4ENG-366). Although hard data are difficult to obtain because of the covert nature of the problem, there is a known link between violence against women and poverty. Figure 7.9 shows percentages of women in selected low-income countries who believed wife-beating was justified as of 2004. The reasons given—presented in the graph's "Note"—are indicative of the status of women in these cultures.

In Addressing Violence against Women and Achieving the Millennium Development Goals (2005, http://www.who.int/gender/documents/MDGs&VAWSept05.pdf), the WHO cites two main reasons poor women are more vulnerable to violence than their nonpoor counterparts: fewer resources—in terms of both money and support services—to help women avoid or escape violence; and the stressors of poverty, such as hunger, unemployment, and lack of education, that may lead some men to become violent or exacerbate an already violent situation. In addition, women who work in unregulated, informal employment are often subject to physical, sexual, or psychological abuse by their employers. In both developing and developed countries, social standards and enforced gender roles contribute to the incidence of violence.

The WHO report recommends several global economic actions that can affect women who are routine victims of violence:

• Promote increased access to postprimary, vocational and technical education for women
• Address gender gaps in earnings as well as barriers to accessing credit for women
• Extend and upgrade childcare benefits to enable women's full participation in the paid labor market
• Address issues of occupational segregation that often translate into inferior conditions of employment for women

• Ensure social protection and benefits for women in precarious employment situations—often those involved in informal employment

The WHO report notes, however, that increasing women's economic and social opportunities can actually put them at greater risk of violence, as such opportunities can breed resentment from the men in their lives. The WHO emphasizes that a well-funded and developed social support system is essential if poor women are to permanently escape violence. Educational programs are particularly important, for both women and men, if perceived gender roles are to be expanded to include advancement for women without the danger of violence.

Exact figures for incidences of violence are almost impossible to obtain, because most violent acts committed against women—especially in developing countries—go unreported. However, it is estimated that 10% to 50% of women around the world have been assaulted by their husbands or male partners at some point. The numbers rise when brothers and other male relatives who perpetrate the violence are counted. In fact, physical and sexual assaults committed by male family members are the most common type of violence against women. In developing countries this type of violence is largely the result of traditional gender norms, most of which have evolved out of men's social and economic dominance over women.

The connection between poverty and violence against women lies primarily in that dominance. In many cultures women are completely dependent on their husbands and male relatives for survival. Amnesty International cites laws that prohibit women from owning or inheriting property and from divorcing abusive husbands; hierarchies that allow fathers, brothers, and husbands to withhold access to food, clothing, and shelter; and customs, such as "wife inheritance" and honor crimes, that force women to obey male relatives or risk exile or death.

In addition, violent conflicts at the village, tribal, and national level reduce millions of women and children to refugee status, leaving them vulnerable to unemployment, disease, starvation, rape, and kidnapping. Millions more women and children (the UN estimates thirty million worldwide) end up as victims of international sex trafficking; the U.S. Department of Health and Human Services' Administration for Children and Families reports that poor women may be lured into the sex trade by promises of a good job in another country, or they may be sold into the trade by their parents, brothers, husbands, or male partners. Others are abducted and forced into the trade. Taken together, these factors leave poor women especially vulnerable to physical, sexual, and psychological violence.

Furthermore, a woman who has suffered domestic violence is more likely to become impoverished. Globally, with as many as one in three women being violently assaulted in her lifetime, the chances of severe, debilitating injury to a large number of abused women are high. In a November 2005 address before the U.S. Congressional Human Rights Caucus, S. K. Guha of UNIFEM noted that violence against women is increasingly acknowledged to be both a consequence and a cause of poverty among women and children. Severely abused women are generally unable to work, especially if they are also responsible for performing the physical labor of harvesting food and gathering fuel and water for their families.

Violence against Women in the United States

In the United States domestic violence is conclusively linked to homelessness among women and children. The American Civil Liberties Union (ACLU) reports that domestic violence was cited by 50% of U.S cities surveyed in 2005 as a primary cause of homelessness (http://www.aclu.org/pdfs/dvhomelessness032106.pdf). Further, the ACLU notes that 50% of homeless women in San Diego, California, reported being the victims of domestic violence, and that in Minnesota, one-third of homeless women indicated that they left their homes to escape domestic violence. Overall, according to the National Network to End Domestic Violence, Domestic Violence (September 2004; http://www.nnedv.org/pdf/Homelessness.pdf), 92% of homeless women in the United States have at some point been the victims of severe physical and/or sexual abuse.

VIOLENCE AGAINST WOMEN ACT 2005

In December 2005 both the U.S. Senate and House of Representatives passed the Violence against Women Act 2005 (VAWA), which was part of the larger Department of Justice authorization bill. The VAWA 2005 is a reauthorization of an earlier act passed in 1994. The 2005 version of VAWA enhanced the provisions of its earlier version, with increased funding for violence-prevention programs, emergency shelter for women and children, and long-term housing solutions for low-income women and their children. The act also mandates that abused women be allowed to take ten days off from work each year to attend court or to look for housing, and it provides greater access to law enforcement and the justice system for abused immigrant woman who would otherwise have no legal recourse and might have to leave the country with abusive partners. Because violent relationships tend to affect poor women disproportionately in the United States, the provisions of the VAWA that allow time off from work and help for immigrant women mean that more poor women will be able to keep their jobs and remain in the country while they make arrangements to leave and/or prosecute their abusers.

POVERTY'S YOUNGEST VICTIMS

According to the report State of the World's Children 2006: Excluded and Invisible (2005, http://www.unicef.org/egypt/sowc06_fullreport.pdf) by the United Nations Children's Fund's (UNICEF), the least developed countries in the world are home to the greatest number of children—49% of the total population of least developed countries was under eighteen years old in 2004; in developing countries children under eighteen made up 37% of the total population. (See Figure 7.10.)

Children are more vulnerable to the effects of poverty than any other demographic group, and because their numbers in poor countries are so high, they suffer disproportionately from the disease, hunger, abuse, and exploitation that so often go hand in hand with poverty. UNICEF reports that "more than one billion children suffer from one or more extreme forms of deprivation in adequate nutrition, safe drinking water, decent sanitation facilities, health-care services, shelter, education and information." As Figure 7.11 shows, 30.7% of children in developing countries have no access to a toilet, while 33.9% live in homes with more than five people per room. For 21.1%, there is access only to untreated, potentially hazardous, water sources. Furthermore, 13.1% have never been to school. Underdeveloped and developing countries overall have the highest rates of children not attending school, as shown in Figure 7.12. Whereas 96% of girls and 95% of boys in developed countries are enrolled in primary school, just 65% of girls and 71% of boys in underdeveloped ("least developed") countries are enrolled in primary school. Even fewer poor children are enrolled in secondary school: 26% of girls and 30% of boys in underdeveloped countries, versus 92% of girls and 91% of boys in developed countries.

Table 7.8 lists each country's rank according to its under-five mortality rate, as well as each country's infant and under-five mortality rates, life expectancy, literacy and education rates, and gross national per capita income. In general, life expectancy at birth increases as gross national income per capita increases. Infant and under-five mortality rates improved overall between 1990 and 2004 in least developed, developing, and industrialized countries.

Table 7.9 shows the status of child protection in countries around the world. Western and Central African countries have the overall highest percentage of children involved in child labor (41% of both girls and boys). At 46%, South Asia has the highest rate of child marriage of any geographic region, followed closely by Western and Central Africa, at 45%.

Child poverty is not limited to low-income countries. In eleven out of the fifteen countries belonging to the Organization for Economic Cooperation and Development (OECD), child poverty increased from the period of the late 1980s–early 1990s through the late 1990s–early 2000s. In this group, Mexico had the highest rate of child poverty, rising from 24.7% in the earlier period to 27.7% in the later period. The United States had the second highest rate; even with a drop from 24.3% to 21.9%, the U.S. child poverty rate far exceeded the rate of all other OECD countries except Mexico. In the United Kingdom the drop from 18.5% to 15.4% was due in large part to the commitment

of the government to eliminating child poverty by entirely by 2020 (see Chapter 6)

UNICEF's 2000 publication Poverty Reduction Begins with Children (http://www.unicef.org/publications/files/pub_poverty_reduction_en.pdf) emphasizes the special challenges of children who live in poverty and discusses how child poverty differs from poverty in general. Because childhood—particularly the first few months of a person's life—is a time of key developmental changes physically, emotionally, and intellectually, neglect in any of these areas can be a permanent detriment to future well-being. According to UNICEF, impoverished children become "transmitters" of poverty to the next generation when they become parents themselves. The report maintains that this cycle can be broken only when poverty is considered a human rights violation instead of simply a matter of income deprivation.

Children's Health and Mortality

Improving children's health and reducing rates of child mortality is an implicit factor of the Convention on the Rights of the Child and is explicitly listed as one of the Millennium Development Goals. The most fundamental and important indicators of poverty among children are the state of their health and their rates of mortality. Child mortality rates are also a major indicator of the overall social and economic stability of nations. How much a country invests—or does not invest—in measures to cut back preventable deaths and diseases of children is ultimately indicative of its commitment to its own economic development.

Table 7.10 and Table 7.11 show basic human development indicators in industrialized and developing countries, respectively. Notice that in industrialized countries the percentage of moderately or severely underweight children under five is negligible, while in developing countries the rate is high, at 27%. Additionally, rates of childhood immunization differ markedly in the two income categories. In industrialized countries at least 92% of children are immunized against measles, diphtheria/pertussis/tetanus, polio, and haemophilus influenzae, while, at most, 79% of children in developing countries have been immunized against these common illnesses.

INFANT MORTALITY

The WHO's World Health Report 2005 states that of the approximately 136 million babies born each year, at least 3.3 million are stillborn, more than four million die before they are twenty-eight days old, and 6.6 million die before their fifth birthday. The WHO estimates that 98% of all newborn deaths happen in the developing world—28% in sub-Saharan Africa and 36% in Southeast Asia. As of 2005, newborn deaths accounted for more than half of all infant deaths and 40% of all deaths of children under five. As a region, Southeast Asia had the highest overall number of stillbirths and newborn deaths—1.3 million and 1.4 million, respectively—but sub-Saharan Africa had the highest newborn death rate, at about forty-five newborn deaths per 1,000 live births in that region.

By comparison, in the United States the infant death rate (counting all infants under twelve months old) was 6.84 per 1,000 live births in 2003, down slightly from the 2002 rate of 6.95, according to the Rights for Disease Control (CDC) in "Infant Mortality Statistics from the 2003 Period Linked Birth/Infant Death Data Set" (National Vital Statistics Reports, vol. 54, no. 16, May 3, 2006). Wide disparities in infant death rates exist among racial and ethnic groups in the United States, ranging from a low of 4.83 per 1,000 live births for Asians and Pacific Islanders to a high of 13.6 per 1,000 live births for African-Americans. In addition, infants born to teenagers and women over forty have higher rates of mortality than those in the middle years of childbearing age. Likewise, infant death rates decrease among women with higher levels of education, and rates tend to be higher among unmarried women. According to the CDC report, all of these risk factors may be linked to a mother's socioeconomic status, which is in itself a major risk factor in infant death. Lower-income women are less likely to have the financial means to get early prenatal care, and their babies are also less likely to receive quality health care.

Although the overall U.S. infant mortality rate is significantly lower than rates in developing countries, the U.S. rate is more than double that of the countries with the lowest infant mortality. According to statistics reported by the UNDP in its Human Development Report 2005, Hong Kong, Singapore, Iceland, Japan and Sweden had the lowest rates in 2003 at three per 1,000 live births, and Sierra Leone had the highest with 182 deaths per 1,000 live births in 2003.

MORTALITY OF CHILDREN UNDER FIVE

Children's health programs begun in the 1970s and 1980s have significantly reduced certain diseases and illnesses. Incidence of polio, for example, went from 350,000 cases reported in 1988 to 1,185 cases reported in 2005, thanks to the success of polio vaccination programs (World Health Report 2005). However, approximately 10.6 million children per year still die before their fifth birthday. Table 7.12 ranks countries according to their under-five mortality rate ("value" refers to the number of deaths per 1,000 live births; countries are listed in worst-to-best order).

Figure 7.13 shows that progress has been made since 1970 in reducing the mortality rate of children under five years old. In 1970 the worldwide mortality rate for young children was 146 per 1,000 live births; by 2003 it was 79 per 1,000. Still, more than 70% of child deaths in 2003 occurred in just two regions: Africa and Southeast Asia. The WHO further notes in World Health Report 2005 that half of all deaths of children under five in 2003 occurred in just six countries: China, the Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan.

According to the WHO, just six illnesses account for 70% to 90% of the deaths of young children: 19% are from acute lower respiratory infections (typically pneumonia), 17% from diarrhea, 8% from malaria, 4% from measles, 3% from HIV/AIDS, and 37% from neonatal conditions. Africa by far accounts for the most deaths of children from malaria and HIV/AIDS (90%), measles (more than 50%), and pneumonia and diarrhea (40%). (See Figures 7.14 and 7.15.)

Child Labor

Children from poor families frequently must go to work to contribute income to their household, and of all the poverty-related abuses and deprivations children suffer, child labor is among the worst, resulting in physical and psychological damage and, frequently, premature death. The United Nations, the International Labor Organization (ILO), and other NGOs distinguish, however, between "child work" (economic activity by children at least twelve years old that is not hazardous and does not interfere with their education) and "child labor" (all work by children under age twelve; hazardous work by children aged twelve to fourteen; and all work defined as "worst forms of child labor"). "Worst forms of child labor," as defined by the ILO, include: