The millennium development goals (MDGs) have driven “the most successful anti-poverty movement in history” and brought more than a billion people out of extreme penury, but their achievements have been mixed and the world remains deeply riven by inequality, the UN’s final report (pdf) on the goals has concluded.
Ban Ki-moon, the UN secretary general, said that while the 15-year push to meet the eight goals – on poverty, education, gender equality, child mortality, maternal health, disease, the environment and global partnership – had yielded some astonishing results, it had left too many people behind.
“The MDGs helped to lift more than one billion people out of extreme poverty, to make inroads against hunger, to enable more girls to attend school than ever before and to protect our planet,” he said.
“Yet for all the remarkable gains, I am keenly aware that inequalities persist and that progress has been uneven.”
While the world has reduced the number of people living on less than $1.25 a day from 1.9 billion in 1990 to 836 million in 2015, the target of halving the proportion of people suffering from hunger was narrowly missed.
Between 1990 and 2015, the proportion of undernourished people fell from 23.3% to 12.9%. Current estimates suggest around 795 million people are undernourished – the overwhelming majority of them in developing regions. Progress has been hindered by higher food and energy prices, extreme weather, natural disasters, political instability, humanitarian crises and the economic recession of the late 1990s and in 2008-2009.
Ban noted that in 2011, nearly 60% of the world’s extremely poor people lived in five countries – India, Nigeria, China, Bangladesh and the Democratic Republic of Congo – and that familiar divisions and inequities were as stark as ever.
“Too many women continue to die during pregnancy or from childbirth-related complications,” he said. “Progress tends to bypass women and those who are lowest on the economic ladder or are disadvantaged because of their age, disability or ethnicity. Disparities between rural and urban areas remain pronounced.”
Progress on education has been mixed: the goal of achieving universal primary education has also just been missed, with the net enrolment rate rising from 83% in 2000 to 91% this year. The literacy rate for those aged 15 to 24 showed an identical rise, while the number of out-of-school children fell from 100 million 15 years ago to 57 million today.
Despite having to contend with a rising population, high levels of poverty and armed conflicts, sub-Saharan Africa made the greatest progress in primary school enrolment of all the developing regions, with its rate growing from 52% in 1990 to 78% in 2012.
The push for gender equality and to empower women has led to about two-thirds of developing countries achieving gender parity in primary education – underlining the fact that the aspiration of eliminating gender disparity in primary and secondary education has not been met.
When it comes to employment outside the agricultural sector, women now constitute 41% of paid workers, up from 35% in 1990. Although the proportion of women in parliament has nearly doubled over the past 20 years, only one in every five seats is held by a woman. Efforts to narrow the gender divide continue to be stymied by discrimination in law and practice, violence against women and girls, unequal employment opportunities and unequal division of unpaid care and domestic work.
While the child mortality rate has declined by more than half over the past 25 years – falling from 90 to 43 deaths per 1,000 live births – it has not declined by the MDG aim of two-thirds. Vaccination helped to prevent nearly 15.6m deaths from measles between 2000 and 2013, but that progress has slowed since 2010, with an estimated 21.6 million infants not receiving the vaccine in 2013. The biggest preventable causes of death for children under five are pneumonia, diarrhoea and malaria, which between them claim 16,000 lives a day.
The aspiration of reducing the maternal mortality ratio by three-quarters has not been realised, with the ratio falling by nearly half (from 380 deaths per 100,000 live births to 210). Today, only half of pregnant women in developing regions receive the recommended minimum of four antenatal visits, and a quarter of babies worldwide are delivered without skilled care. Postpartum haemorrhage accounted for 27% of maternal deaths in developing regions between 2003 and 2009; other major complications were high blood pressure during pregnancy, complications from delivery and unsafe abortion.
Progress on combating HIV/Aids, malaria and other diseases has also varied. The target of halting and beginning to reverse the spread of HIV/Aids by 2015 has not been met, although the number of new HIV infections fell by around 40% between 2000 and 2013, from 3.5 million cases to 2.1 million. The fight is being hindered by risky sexual behaviour and a lack of basic knowledge about HIV among young people in many countries.
The target of halting and reversing the incidence of malaria has been achieved thanks to a tenfold increase in international financing since 2000 and sustained malaria prevention and treatment initiatives. Insecticide-treated mosquito nets, indoor spraying, diagnostic testing and the use of effective drugs have helped prevent more than 6.2m deaths from the disease between 2000 and 2015. The global malaria incidence rate has fallen by more than a third and the mortality rate by more than half. Significant progress has been made in the fight against tuberculosis: improved prevention, diagnosis and treatment saved an estimated 37m lives between 2000 and 2013.
The push for environmental sustainability has brought some 2.6 billion people access to improved drinking water since 1990, meaning that the target of halving the proportion of people without access to improved sources of water was achieved in 2010 – five years ahead of schedule. However, 663 million are still without improved drinking water.
Efforts on sanitation have fared far less well: 2.1 billion people have gained access to improved sanitation (a toilet that hygienically separates faeces from human contact) since 1990, leaving the target of halving the number of people without access to basic sanitation short by nearly 700 million people.
Some 2.4 billion people in developing countries – a third of humanity – still lack access to improved sanitation facilities, while 946 million people still practise open defecation.
The differences between rural and urban areas are often considerable. While four out of five people in urban areas have access to piped drinking water, the figure for those in rural areas is just one in three. Nearly half of those in rural areas lack access to improved sanitation facilities compared with less than a fifth of those in urban areas.
Moves to improve the way the world works together on development have been aided by an increase in the amount of official development assistance (ODA) that rich countries give to developing nations. Between 2000 and 2014, ODA increased by 66% in real terms and hit a record high of $134.8bn (£80.3bn) in 2013.
Ban said that lessons had to be learned from the MDGs as the world prepares to agree their successors, the sustainable development goals, which will set the agenda for the next 15 years.
“We need to tackle root causes and do more to integrate the economic, social and environmental dimensions of sustainable development,” he said.
“Reflecting on the MDGs and looking ahead to the next 15 years, there is no question that we can deliver on our shared responsibility to end poverty, leave no one behind and create a world of dignity for all.”