(c) Reduction of severe and moderate malnutrition among under-5 children by one half of 1990 levels;
(d) Universal access to safe drinking water and to sanitary means of excreta disposal;
(e) Universal access to basic education and completion of primary education by at least 80 per cent of primary school age children;
(f) Reduction of the adult illiteracy rate to at least half its 1990 level (the appropriate age group to be determined in each country), with emphasis on female literacy;
(g) Protection of children in especially difficult circumstances, particularly in situations of armed conflicts.
6. A list of more detailed sectoral goals and specific actions which would enable the attainment of the above major goals can be found in the appendix to this Plan of Action. These goals will first need to be adapted to the specific realities of each country in terms of phasing, priorities, standards and availability of resources. The strategies for the achievement of the goals may also vary from country to country. Some countries may wish to add other development goals that are uniquely important and relevant for their specific country situation. Such adaptation of the goals is of crucial importance to ensure their technical validity, logistical feasibility, financial affordability and to secure political commitment and broad public support for their achievement.
II. Specific Actions for Child Survival, Protection and Development
7. Within the context of these overall goals, there are promising opportunities for eradicating or virtually eliminating age-old diseases that have afflicted tens of millions of children for centuries and for improving the quality of life of generations to come. Achievement of these goals would also contribute to lowering population growth, as sustained decline in child death rates towards the level at which parents become confident that their first children will survive is, with some time lag, followed by even greater reduction in child births. To seize these opportunities the Declaration of the World Summit for Children calls for specific actions in the following areas:
The Convention on the Rights of the Child
8. The Convention on the Rights of the Child, unanimously adopted by the United Nations General Assembly, contains a comprehensive set of international legal norms for the protection and well-being of children. All Governments are urged to promote earliest possible ratification of the Convention, where it has not already been ratified. Every possible effort should be made in all countries to disseminate the Convention and, wherever it has already been ratified, to promote its implementation and monitoring.
9. Preventable childhood diseases - such as measles, polio, tetanus, tuberculosis, whooping cough and diphtheria, against which there are effective vaccines, and diarrhoeal diseases, pneumonia and other acute respiratory infections that can be prevented or effectively treated through relatively low-cost remedies - are currently responsible for the great majority of the world's 14 million deaths of children under 5 years and disability of millions more every year. Effective action can and must be taken to combat these diseases by strengthening primary health care and basic health services in all countries.
10. Besides these readily preventable or treatable diseases and some others, such as malaria, which have proved more difficult to combat, children today are faced with the new spectre of the acquired immunodeficiency syndrome (AIDS) pandemic. In the most seriously affected countries HIV/AIDS threatens to offset the gains of child survival programmes. It is already a major drain on limited public health resources needed to support other priority health services. The consequences of HIV/AIDS go well beyond the suffering and death of the infected child and include risks and stigmas that affect parents and siblings and the tragedy of "AIDS orphans". There is an urgent need to ensure that programmes for the prevention and treatment of AIDS, including research on possible vaccines and cures that can be applicable in all countries and situations, and massive information and education campaigns, receive a high priority for both national action and international co-operation.
11. A major factor affecting the health of children as well as adults is the availability of clean water and safe sanitation. These are not only essential for human health and well-being, but also contribute greatly to the emancipation of women from the drudgery that has a pernicious impact on children, especially girls. Progress in child health is unlikely to be sustained if one third of the developing world's children remain without access to clean drinking water and half of them without adequate sanitary facilities.
12. Based on the experience of the past decade, including the many innovations in simple, low-cost techniques and technologies to provide clean water and safe sanitary facilities in rural areas and urban shanty towns, it is now desirable as well as feasible, through concerted national action and international co-operation, to aim at providing all the world's children with universal access to safe drinking water and sanitary means of excreta disposal by the year 2000. An important related benefit of universal access to water and sanitation combined with health education will be the control of many water-borne diseases, among them elimination of guinea-worm disease (dracunculiasis), which currently afflicts some 10 million children in parts of Africa and Asia.
Food and nutrition
13. Hunger and malnutrition in their different forms contribute to about half of the deaths of young children. More than 20 million children suffer from severe malnutrition, 150 million are underweight and 350 million women suffer from nutritional anaemia. Improved nutrition requires (a) adequate household food security, (b) healthy environment and control of infections and (c) adequate maternal and child care. With the right policies, appropriate institutional arrangements and political priority, the world is now in a position to feed all the world's children and to overcome the worst forms of malnutrition, i.e. drastically to reduce diseases that contribute to malnutrition, to halve protein-energy malnutrition, virtually to eliminate vitamin A deficiency and iodine deficiency disorders and to reduce nutritional anaemia significantly.
14. For the young child and the pregnant woman, provision of adequate food during pregnancy and lactation; promotion, protection and support of breastfeeding and complementary feeding practices, including frequent feeding; growth monitoring with appropriate follow-up actions; and nutritional surveillance are the most essential needs. As the child grows older, and for the adult population as a whole, an adequate diet is an obvious human priority. Meeting this need requires employment and income-generating opportunities, dissemination of knowledge and supporting services to increase food production and distribution. These are key actions within broader national strategies to combat hunger and malnutrition.
Role of women, maternal health and family planning
15. Women in their various roles play a critical part in the well-being of children. The enhancement of the status of women and their equal access to education, training, credit and other extension services constitute a valuable contribution to a nation's social and economic development. Efforts for the enhancement of women's status and their role in development must begin with the girl child. Equal opportunity should be provided for the girl child to benefit from the health, nutrition, education and other basic services to enable her to grow to her full potential.
16. Maternal health, nutrition and education are important for the survival and well-being of women in their own right and are key determinants of the health and well-being of the child in early infancy. The causes of the high rates of infant mortality, especially neonatal mortality, are linked to untimely pregnancies, low birth weight and pre-term births, unsafe delivery, neonatal tetanus, high fertility rates, etc. These are also major risk factors for maternal mortality claiming the lives of 500,000 young women each year and resulting in ill-health and suffering for many millions more. To redress this tragedy, special attention should be given to health, nutrition and education of women.
17. All couples should have access to information on the importance of responsible planning of family size and the many advantages of child spacing to avoid pregnancies that are too early, too late, too many or too frequent. Pre-natal care, clean delivery, access to referral facilities in complicated cases, tetanus toxoid vaccination and prevention of anaemia and other nutritional deficiencies during pregnancy are other important interventions to ensure safe motherhood and a healthy start in life for the newborn. There is an added benefit of promoting maternal and child health programmes and family planning together in that, acting synergistically, these activities help accelerate the reduction of both mortality and fertility rates, and contribute more to lowering rates of population growth than either type of activity alone.
Role of the family
18. The family has the primary responsibility for the nurturing and protection of children from infancy to adolescence. Introduction of children to the culture, values and norms of their society begins in the family. For the full and harmonious development of their personality, children should grow up in a family environment, in an atmosphere of happiness, love and understanding. Accordingly, all institutions of society should respect and support the efforts of parents and other care-givers to nurture and care for children in a family environment.
19. Every effort should be made to prevent the separation of children from their families. Whenever children are separated from their family owing to force majeur or in their own best interest, arrangements should be made for appropriate alternative family care or institutional placement, due regard being paid to the desirability of continuity in a child's upbringing in his or her own cultural milieu. Extended families, relatives and community institutions should be given support to help to meet the special needs of orphaned, displaced and abandoned children. Efforts must be made to ensure that no child is treated as an outcast from society.
Basic education and literacy
20. The international community, including virtually all the Governments of the world, have undertaken a commitment at the World Conference on Education for All at Jomtien, Thailand, to increase significantly educational opportunity for over 100 million children and nearly 1 billion adults, two thirds of them girls and women, who at present have no access to basic education and literacy. In fulfilment of that commitment, specific measures must be adopted for (a) the expansion of early childhood development activities, (b) universal access to basic education, including completion of primary education or equivalent learning achievement by at least 80 per cent of the relevant school age children with emphasis on reducing the current disparities between boys and girls, (c) the reduction of adult illiteracy by half, with emphasis on female literacy, (d) vocational training and preparation for employment and (e) increased acquisition of knowledge, skills and values through all educational channels, including modern and traditional communication media, to improve the quality of life of children and families.
21. Besides its intrinsic value for human development and improving the quality of life, progress in education and literacy can contribute significantly to improvement in maternal and child health, in protection of the environment and in sustainable development. As such, investment in basic education must be accorded a high priority in national action as well as international co-operation.
Children in especially difficult circumstances
22. Millions of children around the world live under especially difficult circumstances - as orphans and street children, as refugees or displaced persons, as victims of war and natural and man-made disasters, including such perils as exposure to radiation and dangerous chemicals, as children of migrant workers and other socially disadvantaged groups, as child workers or youth trapped in the bondage of prostitution, sexual abuse and other forms of exploitation, as disabled children and juvenile delinquents and as victims of apartheid and foreign occupation. Such children deserve special attention, protection and assistance from their families and communities and as part of national efforts and international co-operation.
23. More than 100 million children are engaged in employment, often heavy and hazardous and in contravention of international conventions which provide for their protection from economic exploitation and from performing work that interferes with their education and is harmful to their health and full development. With this in mind, all States should work to end such child-labour practices and see how the conditions and circumstances of children in legitimate employment can be protected to provide adequate opportunity for their healthy upbringing and development.
24. Drug abuse has emerged as a global menace to very large numbers of young people and, increasingly, children - including permanent damage incurred in the pre-natal stages of life. Concerted action is needed by Governments and intergovernmental agencies to combat illicit production, supply, demand, trafficking and distribution of narcotic drugs and psychotropic substances to counter this tragedy. Equally important is community action and education, which are vitally needed to curb both the supply of and the demand for illicit drugs. Tobacco and alcohol abuse are also problems requiring action, especially preventive measures and education among young people.
Protection of children during armed conflicts
25. Children need special protection in situations of armed conflict. Recent examples in which countries and opposing factions have agreed to suspend hostilities and adopt special measures such as "corridors of peace" to allow relief supplies to reach women and children and "days of tranquillity" to vaccinate and to provide other health services for children and their families in areas of conflict need to be applied in all such situations. Resolution of a conflict need not be a prerequisite for measures explicitly to protect children and their families to ensure their continuing access to food, medical care and basic services, to deal with trauma resulting from violence and to exempt them from other direct consequences of violence and hostilities. To build the foundation for a peaceful world where violence and war will cease to be acceptable means for settling disputes and conflicts, children's education should inculcate the values of peace, tolerance, understanding and dialogue.
Children and the environment
26. Children have the greatest stake in the preservation of the environment and its judicious management for sustainable development as their survival and development depends on it. The child survival and development goals proposed for the 1990s in this Plan of Action seek to improve the environment by combating disease and malnutrition and promoting education. These contribute to lowering death rates as well as birth rates, improved social services, better use of natural resources and, ultimately, to the breaking of the vicious cycle of poverty and environmental degradation.
27. With their relatively low use of capital resources and high reliance on social mobilization, community participation and appropriate technology, the programmes designed to reach the child-related goals of the 1990s are highly compatible with and supportive of environmental protection. The goals for the survival, protection and development of children as enunciated in this Plan of Action should therefore be seen as helping to protect and preserve the environment. Still more action is needed, of course, to prevent the degradation of the environment in both the industrialized and the developing countries, through changes in the wasteful consumption patterns of the affluent and by helping to meet the necessities of survival and development of the poor. Programmes for children that not only help to meet their basic needs but which inculcate in them respect for the natural environment with the diversity of life that it sustains and its beauty and resourcefulness that enhance the quality of human life, must figure prominently in the world's environmental agenda.
Alleviation of poverty and revitalization of economic growth
28. Achievement of child related goals in the areas of health, nutrition, education, etc., will contribute much to alleviating the worst manifestations of poverty. But much more will need to be done to ensure that a solid economic base is established to meet and sustain the goals for long- term child survival, protection and development.
29. As affirmed by the international community at the eighteenth special session of the United Nations General Assembly (April 1990), a most important challenge for the 1990s is the need for revitalization of economic growth and social development in the developing countries and to address together the problems of abject poverty and hunger that continue to afflict far too many people in the world. As the most vulnerable segment of human society, children have a particular stake in sustained economic growth and alleviation of poverty, without which their well-being cannot be secured.
30. To foster a favourable international economic environment, it is essential to continue to give urgent attention to an early, broad and durable solution to the external debt problems facing developing debtor countries; to mobilize external and domestic resources to meet the increasing needs for development finance of developing countries; to take steps to ensure that the problem of the net transfer of resources from developing to developed countries does not continue in the 1990s and that its impact is effectively addressed; to create a more open and equitable trading system to facilitate the diversification and modernization of the economies of developing countries, particularly those that are commodity-dependent; and to make available substantial concessional resources, particularly for the least developed countries.
31. In all of these efforts the fulfilment of the basic needs of children must receive a high priority. Every possible opportunity should be explored to ensure that programmes benefiting children, women and other vulnerable groups are protected in times of structural adjustments and other economic restructuring. For example, as countries reduce military expenditures, part of the resources released should be channelled to programmes for social and economic development, including those benefiting children. Debt- relief schemes could be formulated in ways that the budget reallocations and renewed economic growth made possible through such schemes would benefit programmes for children. Debt relief for children, including debt swaps for investment in social development programmes, should be considered by debtors and creditors. The international community, including private-sector creditors, are urged to work with developing countries and relevant agencies to support debt relief for children. To match increased efforts by developing countries themselves, the donor countries and international institutions should consider targetting more development assistance to primary health care, basic education, low-cost water and sanitation programmes and other interventions specifically endorsed in the Summit Declaration and this Plan of Action.
32. The international community has recognized the need to stop and reverse the increasing marginalization of the least developed countries, including most countries of sub-Saharan Africa and many land-locked and island countries that face special development problems. These countries will require additional long-term international support to complement their own national efforts to meet the pressing needs of children over the 1990s.
III. Follow-up Actions and Monitoring
33. Effective implementation of this Plan of Action will require concerted national action and international co- operation. As affirmed in the Declaration, such action and co-operation must be guided by the principle of a "first call for children" - a principle that the essential needs of children should be given high priority in the allocation of resources, in bad times as well as in good times, at national and international as well as at family levels.
34. It is particularly important that the child-specific actions proposed must be pursued as part of strengthening broader national development programmes combining revitalized economic growth, poverty reduction, human resource development and environmental protection. Such programmes must also strengthen community organizations, inculcate civic responsibility and be sensitive to the cultural heritage and social values which support progress without alienation of the younger generation. With these broad objectives in mind, we commit ourselves and our Governments to the following actions:
Action at the national level
(i) All Governments are urged to prepare, before the end of 1991, national programmes of action to implement the commitments undertaken in the World Summit Declaration and this Plan of Action. National Governments should encourage and assist provincial and local governments as well as NGOs, the private sector and civic groups to prepare their own programmes of action to help to implement the goals and objectives included in the Declaration and this Plan of Action;
(ii) Each country is encouraged to re-examine in the context of its national plans, programmes and policies, how it might accord higher priority to programmes for the well- being of children in general, and for meeting over the 1990s the major goals for child survival, development and protection as enumerated in the World Summit Declaration and this Plan of Action;
(iii) Each country is urged to re-examine in the context of its particular national situation, its current national budget, and in the case of donor countries, their development assistance budgets, to ensure that programmes aimed at the achievement of goals for the survival, protection and development of children will have a priority when resources are allocated. Every effort should be made to ensure that such programmes are protected in times of economic austerity and structural adjustments;
(iv) Families, communities, local governments, NGOs, social, cultural, religious, business and other institutions, including the mass media, are encouraged to play an active role in support of the goals enunciated in this Plan of Action. The experience of the 1980s shows that it is only through the mobilization of all sectors of society, including those that traditionally did not consider child survival, protection and development as their major focus, that significant progress can be achieved in these areas. All forms of social mobilization, including the effective use of the great potential of the new information and communication capacity of the world, should be marshalled to convey to all families the knowledge and skills required for dramatically improving the situation of children;
(v) Each country should establish appropriate mechanisms for the regular and timely collection, analysis and publication of data required to monitor relevant social indicators relating to the well-being of children - such as neonatal, infant and under-5 mortality rates, maternal mortality and fertility rates, nutritional levels, immunization coverage, morbidity rates of diseases of public health importance, school enrolment and achievement and literacy rates - which record the progress being made towards the goals set forth in this Plan of Action and corresponding national plans of action. Statistics should be disaggregated by gender to ensure that any inequitable impact of programmes on girls and women can be monitored and corrected. It is particularly important that mechanisms be established to alert policy makers quickly to any adverse trends to enable timely corrective action. Indicators of human development should be periodically reviewed by national leaders and decision makers, as is currently done with indicators of economic development;
(vi) Each country is urged to re-examine its current arrangements for responding to natural disasters and man- made calamities which often afflict women and children the hardest. Countries that do not have adequate contingency planning for disaster preparedness are urged to establish such plans, seeking support from appropriate international institutions where necessary;
(vii) Progress towards the goals endorsed in the Summit Declaration and this Plan of Action could be further accelerated, and solutions to many other major problems confronting children and families greatly facilitated, through further research and development. Governments, industry and academic institutions are requested to increase their efforts in both basic and operational research, aimed at new technical and technological breakthroughs, more effective social mobilization and better delivery of existing social services. Prime examples of the areas in which research is urgently needed include, in the field of health, improved vaccination technologies, malaria, AIDS, respiratory infections, diarrhoeal diseases, nutritional deficiencies, tuberculosis, family planning and care of the newborn. Similarly there are important research needs in the area of early child development, basic education, hygiene and sanitation, and in coping with the trauma facing children who are uprooted from their families and face other particularly difficult circumstances. Such research should involve collaboration among institutions in both the developing and the industrialized countries of the world.
Action at the international level
35. Action at the community and national levels is, of course, of critical importance in meeting the goals and aspirations for children and development. However, many developing countries, particularly the least developed and the most indebted ones, will need substantial international co-operation to enable them to participate effectively in the world-wide effort for child survival, protection and development. Accordingly, the following specific actions are proposed to create an enabling international environment for the implementation of this Plan of Action.
(i) All international development agencies - multilateral, bilateral and non-governmental - are urged to examine how they can contribute to the achievement of the goals and strategies enunciated in the Declaration and this Plan of Action as part of more general attention to human development in the 1990s. They are requested to report their plans and programmes to their respective governing bodies before the end of 1991 and periodically thereafter;
(ii) All regional institutions, including regional political and economic organizations, are requested to include consideration of the Declaration and this Plan of Action on the agenda of their meetings, including at the highest political level, with a view to developing agreements for mutual collaboration for implementation and ongoing monitoring;
(iii) Full co-operation and collaboration of all relevant United Nations agencies and organs as well as other international institutions is requested in ensuring the achievement of the goals and objectives of the national plans envisaged in the World Summit Declaration and Plan of Action. The governing bodies of all concerned agencies are requested to ensure that within their mandates the fullest possible support is given by these agencies for the achievement of these goals;
(iv) The assistance of the United Nations is requested to institute appropriate mechanisms for monitoring the implementation of this Plan of Action, using existing expertise of the relevant United Nations statistical offices, the specialized agencies, UNICEF and other United Nations organs. Furthermore, the Secretary-General of the United Nations is requested to arrange for a mid-decade review, at all appropriate levels, of the progress being made towards implementing the commitments of the Declaration and Plan of Action;
(v) As the world's lead agency for children, the United Nations Children's Fund is requested to prepare, in close collaboration with the relevant specialized agencies and other United Nations organs, a consolidated analysis of the plans and actions undertaken by individual countries and the international community in support of the child-related development goals for the 1990s. The governing bodies of the relevant specialized agencies and United Nations organs are requested to include a periodic review of the implementation of the Declaration and this Plan of Action at their regular sessions and to keep the General Assembly of the United Nations, through the Economic and Social Council, fully informed of progress to date and additional action required during the decade ahead.
36. The goals enunciated in the Declaration and this Plan of Action are ambitious and the commitments required to implement them will demand consistent and extraordinary effort on the part of all concerned. Fortunately, the necessary knowledge and techniques for reaching most of the goals already exist. The financial resources required are modest in relation to the great achievements that beckon. And the most essential factor - the provision to families of the information and services necessary to protect their children - is now within reach in every country and for virtually every community. There is no cause which merits a higher priority than the protection and development of children, on whom the survival, stability and advancement of all nations - and, indeed, of human civilization - depends. Full implementation of the Declaration and this Plan of Action must therefore be accorded a high priority for national action and international co-operation.