● Above 75%urban Between 50%and 75%urban Between 25%and 50%urban Russian Federation Below 25%urban 104.6 73% China 629.8 Urban population in millions atic Peo 147 60% stan 47% Republic star Percentage urban of Korea 71 Japan 40.0 84.6 Iran Pakistan 83% (Islamic 67% Republic of) 62.3 52.3 36% 71% hutan Bangladesh 41.7 India 28% blic Viet Nam 181 26.7 367.5 34% 30% Thailand Philippines 45.6 30% 49% 20.5 729% ●Brunei Darussalam ●Maldives ●Timor-Leste Indonesia 106.2 ●Papua New Guinea 44% ●Solomon Islands Australia ●可 19.8 89% Ne Notes:Because of the cession in July 2011 of the Republic of South Sudan by the Republic of the Sudan,and its subsequent admission to the United Nations on 14 July 2011, data for the Sudan and South Sudan as separate States are not yet available.Data presented are for the Sudan pre-cession. Data for China do not include Hong Kong and Macao,Spe ministrative Regions of China.Hong Kong became a Special Administrative Region (SAR)of China as of 1 July 1997: Macao became a SAR of China as of 20 December 1999. Data for France do not include French Guiana,Guadeloupe,Martinique,Mayotte and Reunion Data for the Netherlands do not include the Netherlands Antilles. Data for the United States of America do not include Puerto Rico and United States Virgin Islands An urban world vii
An urban world vii Notes: Because of the cession in July 2011 of the Republic of South Sudan by the Republic of the Sudan, and its subsequent admission to the United Nations on 14 July 2011, data for the Sudan and South Sudan as separate States are not yet available. Data presented are for the Sudan pre-cession. Data for China do not include Hong Kong and Macao, Special Administrative Regions of China. Hong Kong became a Special Administrative Region (SAR) of China as of 1 July 1997; Macao became a SAR of China as of 20 December 1999. Data for France do not include French Guiana, Guadeloupe, Martinique, Mayotte and Reunion. Data for the Netherlands do not include the Netherlands Antilles. Data for the United States of America do not include Puerto Rico and United States Virgin Islands. Venezuela (Bolivarian Republic of) 27.1 93% Brazil 168.7 87% Argentina 37.3 92% Trinidad and Tobago Uruguay Barbados Bahamas Belize Suriname Guyana Chile 15.2 89% Bolivia (Plurinational State of) Peru 22.4 77% Colombia 34.8 75% Ecuador 9.7 Panama Paraguay Costa Rica Nicaragua El Salvador Honduras Guatemala 7.1 Dominican Republic Cuba 8.5 Haiti Jamaica Mexico 88.3 78% United States of America 255.4 82% Canada 27.4 81% Switzerland Italy 41.4 68% Ukraine 31.3 69% Germany 60.8 74% Estonia Latvia Lithuania Belarus 7.2 Poland 23.3 61% Czech Republic 7.7 Slovakia Austria Hungary Romania 12.3 57% Republic of Moldova Slovenia Croatia Serbia Albania Bulgaria Bosnia and Herzegovina Netherlands 13.8 United 83% Kingdom 49.4 80% Ireland Belgium 10.4 97% France 53.5 85% Spain 35.7 77% Portugal Russian Federation 104.6 73% Greece Turkey 50.7 70% Georgia Armenia Azerbaijan Turkmenistan Norway Sweden 7.9 Denmark Finland Montenegro Luxembourg Malta Iceland The former Yugoslav Republic of Macedonia Mongolia China 629.8 47% Urban population in millions Percentage urban India 367.5 30% Sri Lanka Nepal Bhutan Bangladesh 41.7 28% Myanmar 16.1 34% Democratic People’s Republic of Korea 14.7 60% Republic of Korea 40.0 83% Canton 14.5 Japan 84.6 67% Fiji Papua New Guinea Solomon Islands Timor-Leste Australia 19.8 89% New Zealand Maldives Kazakhstan 9.4 Uzbekistan 10.0 36% Kyrgyzstan Tajikistan Afghanistan 7.1 Pakistan 62.3 36% Viet Nam 26.7 30% Lao People’s Democratic Republic Cambodia Thailand 23.5 34% Singapore Indonesia 106.2 44% Philippines 45.6 49% Malaysia 20.5 72% Brunei Darussalam Above 75% urban Between 50% and 75% urban Between 25% and 50% urban Below 25% urban Somalia Gambia Guinea-Bissau Senegal Sierra Leone Mauritania Guinea Liberia Mali Burkina Faso Côte d’Ivoire 10.0 51% Ghana 12.6 51% Togo Benin Morocco 18.6 58% Algeria 23.6 66% Tunisia 7.1 Libya Niger Nigeria 78.9 50% Cameroon 11.4 58% Egypt 35.2 Chad 43% Sudan 17.5 40% Democratic Republic of the Congo 23.2 35% Central African Republic Congo Gabon Angola 11.2 59% Namibia South Africa 30.9 62% Eritrea Botswana Cyprus Zimbabwe Ethiopia 13.8 17% Kenya 9.0 Uganda Rwanda Burundi Zambia United Republic of Tanzania 11.8 26% Mozambique 9.0 Madagascar Mauritius Swaziland Lesotho Comoros Qatar Iraq 21.0 66% Iran (Islamic Republic of) 52.3 71% Kuwait Syrian Arab Republic 11.4 56% Israel Jordan Saudi Arabia 22.5 82% United Arab Emirates Yemen Oman 7.6 Occupied Palestinian Territory Bahrain Djibouti Equatorial Guinea Sao Tome and Principe Cape Verde Malawi Lebanon
CONTENTS ACKNOWLEDGEMENTS CHAPTER 4 ACTION...........................................iv Towards cities fit for children.........................49 FOREWORD Policy and collaboration... ….49 Anthony Lake,Executive Director,UNICEF...............v Participatory urban planning and management. .50 Child-Friendly Cities................................55 CHAPTER 1 Non-discrimination.................................55 Children in an increasingly urban world.................1 Nutrition and hunger................................55 An urban future.....................................2 Health......................................................57 Poverty and exclusion................................3 HIV and AIDS............... ....57 Meeting the challenges of an urban future...............8 Water,sanitation and hygiene... ..58 Education.........................................58 CHAPTER 2 Child protection....................................60 Children's rights in urban settings.....................13 Housing and infrastructure..... An environment for fulfilling children's rights...........14 .60 Urban planning for children's safety .61 Health............................................14 Safe cities for girs..................................61 Child survival......................................14 Immunization......................................17 Safe spaces for play.................................62 Maternal and newborn health ........................18 Social capital......................................62 Breastfeeding..................18 Cultural inclusion. 62 Culture and arts .63 Respiratory illness.......... .22 Road traffic injuries................................. 22 HIV and AIDS ……22 Mental health......................................24 CHAPTER 5 Water,sanitation and hygiene .25 Uniting for children in an urban world.................67 Education........................................28 Understand urban poverty and exclusion...............68 Early childhood development. .28 Remove the barriers to inclusion......................70 Primary education..................................29 Put children first...................................73 Protection.........................................31 Promote partnership with the urban poor..............74 Child trafficking....................................31 Work together to achieve results for children............74 Child labour.......................................32 Towards fairer cities................................75 Children living and working on the streets..............32 PANELS CHAPTER 3 Social determinants of urban health....................4 Urban challenges...................................35 Slums:The five deprivations...........................5 Migrant children..… .35 Definitions........................................10 Economic sh0cks..............。。· .40 Violence and crime.................................42 The Convention on the Rights of the Child..............16 The Millennium Development Goals...................33 Disaster risk.......................................45 Agents,not victims.................................38 Armed conflict and children in urban areas.............42 THE STATE OF THE WORLD'S CHILDREN 2012
viii THE STATE OF THE WORLD’S CHILDREN 2012 CONTENTS Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii ACTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv Foreword Anthony Lake, Executive Director, UNICEF . . . . . . . . . . . . . . v Chapter 1 Children in an increasingly urban world . . . . . . . . . . . . . . . . 1 An urban future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Poverty and exclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Meeting the challenges of an urban future . . . . . . . . . . . . . . 8 Chapter 2 Children’s rights in urban settings . . . . . . . . . . . . . . . . . . . . 13 An environment for fulfilling children’s rights . . . . . . . . . . 14 Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Child survival. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Immunization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Maternal and newborn health . . . . . . . . . . . . . . . . . . . . . . . 18 Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Respiratory illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Road traffic injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 HIV and AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Mental health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Water, sanitation and hygiene . . . . . . . . . . . . . . . . . . . . . . . 25 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Early childhood development . . . . . . . . . . . . . . . . . . . . . . . . 28 Primary education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Child trafficking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Child labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Children living and working on the streets . . . . . . . . . . . . . 32 Chapter 3 Urban challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Migrant children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Economic shocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Violence and crime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Disaster risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Chapter 4 Towards cities fit for children . . . . . . . . . . . . . . . . . . . . . . . . 49 Policy and collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Participatory urban planning and management . . . . . . . . . 50 Child-Friendly Cities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Non-discrimination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Nutrition and hunger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 HIV and AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Water, sanitation and hygiene . . . . . . . . . . . . . . . . . . . . . . . 58 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Child protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Housing and infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Urban planning for children’s safety . . . . . . . . . . . . . . . . . . 61 Safe cities for girls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Safe spaces for play . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Social capital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Cultural inclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Culture and arts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Chapter 5 Uniting for children in an urban world . . . . . . . . . . . . . . . . 67 Understand urban poverty and exclusion . . . . . . . . . . . . . . 68 Remove the barriers to inclusion . . . . . . . . . . . . . . . . . . . . . 70 Put children first . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Promote partnership with the urban poor . . . . . . . . . . . . . 74 Work together to achieve results for children . . . . . . . . . . . 74 Towards fairer cities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Panels Social determinants of urban health . . . . . . . . . . . . . . . . . . . 4 Slums: The five deprivations . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 The Convention on the Rights of the Child . . . . . . . . . . . . . 16 The Millennium Development Goals . . . . . . . . . . . . . . . . . . 33 Agents, not victims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Armed conflict and children in urban areas . . . . . . . . . . . . 42
FOCUS ON 1.5 Half of the world's urban population lives in cities Urban disparities....................................6 of fewer than 500,000 inhabitants.................11 Matemal and child health services for the urban poor: 2.1 Wealth increases the odds of survival for children A case study from Nairobi,Kenya.....................20 under the age of 5 in urban areas..................18 Mapping urban disparities to secure child rights.........26 2.2 Children of the urban poor are more likely Helpful strategies in urban emergencies................39 to be undernourished............................19 Women,children,disaster and resilience...............41 2.3 Stunting prevalence among children under Urban HEART:Measuring and 3 years old in urban Kenya........................21 responding to health inequity.... ...52 2.4 HIV is more common in urban areas and The Child-Friendly Cities Initiative: more prevalent among females....................22 Fifteen years of trailblazing work......................56 2.5 In urban areas,access to improved water and sanitation is not keeping pace Upgrading informal settlements in Jeddah.............64 with population growth..........................24 The paucity of intra-urban data.......................69 2.6 Mapping poverty in Lilongwe and Blantyre,Malawi...26 2.7 Tracking health outcomes PERSPECTIVE in London,United Kingdom.......................27 Her Majesty Queen Rania Al Abdullah of Jordan 2.8 Urban income disparities also mean unequal Out of sight,out of reach ............................15 access to water.................................28 Amitabh Bachchan 2.9 School attendance is lower in slums...............30 Reaching every child:Wiping out polio in Mumbai .......23 4.1 Urban HEART planning and implementation cycle....52 Eugen Crai 4.2 Twelve core indicators...........................53 A world apart:The isolation of Roma children...........37 ATD Fourth World Movement Youth Group,New York City 4.3 Design scenarios for an informal settlement.........65 Speaking for ourselves.... ….43 Tuiloma Neroni Slade Pacific challenges...................................46 Jose Clodoveu de Arruda Coelho Neto STATISTICAL TABLES. 81 Building children's lives to build a city..................51 Under-five mortality rankings.........................87 Ricky Martin Table 1.Basic indicators............................88 Trafficked children in our cities: Table 2.Nutrition..................................92 Protecting the exploited in the Americas................54 Table 3.Health....................................96 Celine d'Cruz and Sheela Patel Table 4.HIV/AIDS Home-grown solutions..............................72 .100 Table 5.Education............ ....104 Table 6.Demographic indicators....................108 FIGURES Table 7 Economic indicators.......................112 An urban world..........,................,....i Table8.Women.............116 1.1 Almost half of the world's children live in urban areas....2 Table 9.Child protection...........................120 1.2 Urban population growth is greater in less developed regions.......,.................,.....3 Table 10.The rate of progress.......................125 1.3 Educational attainment can be most Table 11.Adolescents..............................130 unequal in urban areas............................6 Table 12.Equity-Residence........................134 1.4 Urban populations are growing fastest in Table 13.Equity-Household wealth..................138 Asia and Africa..................................9 ABBREVIATIONS..................................142 Contents
Contents ix Focus on Urban disparities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Maternal and child health services for the urban poor: A case study from Nairobi, Kenya . . . . . . . . . . . . . . . . . . . . 20 Mapping urban disparities to secure child rights . . . . . . . . 26 Helpful strategies in urban emergencies . . . . . . . . . . . . . . . 39 Women, children, disaster and resilience . . . . . . . . . . . . . . 41 Urban HEART: Measuring and responding to health inequity . . . . . . . . . . . . . . . . . . . . . . . 52 The Child-Friendly Cities Initiative: Fifteen years of trailblazing work . . . . . . . . . . . . . . . . . . . . . 56 Upgrading informal settlements in Jeddah . . . . . . . . . . . . 64 The paucity of intra-urban data . . . . . . . . . . . . . . . . . . . . . . 69 Perspective Her Majesty Queen Rania Al Abdullah of Jordan Out of sight, out of reach . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Amitabh Bachchan Reaching every child: Wiping out polio in Mumbai . . . . . . 23 Eugen Crai A world apart: The isolation of Roma children . . . . . . . . . . 37 ATD Fourth World Movement Youth Group, New York City Speaking for ourselves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Tuiloma Neroni Slade Pacific challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 José Clodoveu de Arruda Coelho Neto Building children’s lives to build a city..................51 Ricky Martin Trafficked children in our cities: Protecting the exploited in the Americas . . . . . . . . . . . . . . . 54 Celine d’Cruz and Sheela Patel Home-grown solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Figures An urban world . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi 1.1 Almost half of the world’s children live in urban areas . . . 2 1.2 Urban population growth is greater in less developed regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.3 Educational attainment can be most unequal in urban areas . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.4 Urban populations are growing fastest in Asia and Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.5 Half of the world’s urban population lives in cities of fewer than 500,000 inhabitants . . . . . . . . . . . . . . . . 11 2.1 Wealth increases the odds of survival for children under the age of 5 in urban areas . . . . . . . . . . . . . . . . . 18 2.2 Children of the urban poor are more likely to be undernourished . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.3 Stunting prevalence among children under 3 years old in urban Kenya . . . . . . . . . . . . . . . . . . . . . . . 21 2.4 HIV is more common in urban areas and more prevalent among females . . . . . . . . . . . . . . . . . . . 22 2.5 In urban areas, access to improved water and sanitation is not keeping pace with population growth . . . . . . . . . . . . . . . . . . . . . . . . . 24 2.6 Mapping poverty in Lilongwe and Blantyre, Malawi . . 26 2.7 Tracking health outcomes in London, United Kingdom . . . . . . . . . . . . . . . . . . . . . . 27 2.8 Urban income disparities also mean unequal access to water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2.9 School attendance is lower in slums . . . . . . . . . . . . . . 30 4.1 Urban HEART planning and implementation cycle . . . 52 4.2 Twelve core indicators . . . . . . . . . . . . . . . . . . . . . . . . . . 53 4.3 Design scenarios for an informal settlement . . . . . . . . 65 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Statistical tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Under-five mortality rankings . . . . . . . . . . . . . . . . . . . . . . . . 87 Table 1. Basic indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table 2. Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table 3. Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Table 4. HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Table 5. Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table 6. Demographic indicators . . . . . . . . . . . . . . . . . . . 108 Table 7. Economic indicators . . . . . . . . . . . . . . . . . . . . . . 112 Table 8. Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Table 9. Child protection . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Table 10. The rate of progress . . . . . . . . . . . . . . . . . . . . . . 125 Table 11. Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Table 12. Equity – Residence . . . . . . . . . . . . . . . . . . . . . . . 134 Table 13. Equity – Household wealth . . . . . . . . . . . . . . . . . 138 ABBREVIATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
1 UNICEF/NYHQ2005-1185/Roger LeMoyne
CHAPTER 1 © UNICEF/NYHQ2005-1185/Roger LeMoyne
Children in an increasingly urban world The day is coming when the majority of the world's been uneven,and millions of children in marginalized children will grow up in cities and towns.Already,half urban settings confront daily challenges and depriva- of all people live in urban areas.By mid-century,over tions of their rights. two thirds of the global population will call these places home.This report focuses on the children-more than Traditionally,when children's well-being is assessed,a one billion and counting-who live in urban settings comparison is drawn between the indicators for chil- around the world. dren in rural areas and those in urban settings.As expected,urban results tend to be better,whether in Urban areas offer great potential to secure children's terms of the proportion of children reaching their first rights and accelerate progress towards the Millennium or fifth birthday,going to school or gaining access to Development Goals(MDGs).Cities attract and gener- improved sanitation.But these comparisons rest on ate wealth,jobs and investment,and are therefore aggregate figures in which the hardships endured by associated with economic development.The more poorer urban children are obscured by the wealth of urban a country,the more likely it is to have higher communities elsewhere in the city. incomes and stronger institutions.Children in urban areas are often better off than their rural counter- Where detailed urban data are available,they reveal parts thanks to higher standards of health,protection, wide disparities in children's rates of survival,nutritional education and sanitation.But urban advances have status and education resulting from unequal access to Children in an increasingly urban world
Children in an increasingly urban world 1 Children in an increasingly urban world The day is coming when the majority of the world’s children will grow up in cities and towns. Already, half of all people live in urban areas. By mid-century, over two thirds of the global population will call these places home. This report focuses on the children – more than one billion and counting – who live in urban settings around the world. Urban areas offer great potential to secure children’s rights and accelerate progress towards the Millennium Development Goals (MDGs). Cities attract and generate wealth, jobs and investment, and are therefore associated with economic development. The more urban a country, the more likely it is to have higher incomes and stronger institutions.1 Children in urban areas are often better off than their rural counterparts thanks to higher standards of health, protection, education and sanitation. But urban advances have been uneven, and millions of children in marginalized urban settings confront daily challenges and deprivations of their rights. Traditionally, when children’s well-being is assessed, a comparison is drawn between the indicators for children in rural areas and those in urban settings. As expected, urban results tend to be better, whether in terms of the proportion of children reaching their first or fifth birthday, going to school or gaining access to improved sanitation. But these comparisons rest on aggregate figures in which the hardships endured by poorer urban children are obscured by the wealth of communities elsewhere in the city. Where detailed urban data are available, they reveal wide disparities in children’s rates of survival, nutritional status and education resulting from unequal access to