MDG 1: Eradicate extreme poverty and hunger

Almost 27 million children in Europe are at risk of poverty or social exclusion (see online supplementary table). Even in European Union member states, children are more vulnerable to poverty than the rest of the population with 19% of children living under the threat of poverty. The financial and economic crisis that started in 2008 has severely affected children and their families by hitting employment and welfare systems. In the central and eastern areas of the region much has changed since the collapse of the old Soviet Union and many of these countries have not caught up easily. A small minority became very wealthy quickly but many people are worse off than before. The old regime allowed full employment, a minimum income with child cash benefits, free health care and education for many families.1 However, since 1999 nearly 90 million of the 480 million people in eastern Europe and central Asia (about 18% of the population) have moved out of poverty and vulnerability.3

In the report ‘Child well-being in rich countries’ (2013), the relative child poverty rate (percentage of children living below the nation's poverty line) is lowest (4%) in Finland.4 The child poverty gap (the distance between the poverty line and the median incomes for those below the line) is smallest in Luxemburg and Hungary (just over 10%) but it has widened to more than 30% in several countries, including Bulgaria, Ireland and Italy. In Spain 20% or more children fall below the relative poverty line and on average they fall almost 40% below that line. In Austria and The Netherlands 6–8% fall below the relative poverty line and on average 16% below. Among the countries in this report, children's material wellbeing is rated as highest in The Netherlands and lowest in Romania.

Poverty means not only that children's basic needs, such as food, clothes and adequate housing, might not be met. It is linked to social exclusion and lack of access to services, including health care, child care and high-quality education. These effects can last a lifetime and be felt in future generations.

MDG 4: Reduce child mortality

In addition to infant mortality, the under-five mortality rates are dropping across the European region (from 26 to 10 per 1000 live births between 1990 and 2012). However, the decline is less steep than in 1975–1990, with marked variations between countries, for example, under-five mortality rates of 1 in The Netherlands, 4 in the UK and 26 per 1000 live births in Uzbekistan.2 The high average immunisation rates achieved in many countries are falling in some, exacerbated by activities of anti-immunisation lobby groups and fears of complications (often based on inaccurate scientific reports).2

MDG 5: Improve maternal health

Child health is closely related to, and to a large extent dependant on, maternal health. Over the whole region the maternal mortality rate has dropped from 42 to 17 deaths per 100 000 live births between 1990 and 2013. The risk of dying from causes related to pregnancy and childbirth differs greatly across the region, depending on where mothers live, with maternal mortality rates of 4 in Finland and 75 (per 100 000 live births) in Kyrgyzstan.2

MDG 6: Combat HIV/AIDS, malaria and other diseases (including tuberculosis)

Since 2010 paediatric HIV/AIDS has decreased by 10% in the European region, mainly due to a decrease in western countries, even though 75% of infected children were in the east. Mother to child transmission accounted for just 1% of new cases of paediatric HIV/AIDS reported in 2012. Almost 70% of all pregnant women were tested and knew their HIV status in 2011, over 95% of HIV-infected pregnant women had access to antiretroviral therapy and more than 95% of infants of women who were HIV-positive were tested within 2 months of birth. However there are still pregnant women who inject drugs, are sex workers, migrants, prisoners, or have partners at high risk of HIV infection who do not have access to antenatal care or present too late for consultation or treatment.5

Tuberculosis (TB) is still an important problem in the European region. During 2006–2010 TB notification in children (0–14 years) decreased by 10% from 7.0 to 6.3 cases per 100 000 population but in 20 of the region's countries children represented more than 5% of all TB cases. Poor adherence to control practices has created high levels of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB. Of the 27 countries globally responsible for most MDR-TB cases, 15 are in the European region.3

MDG 2: Achieve universal primary education

Almost all children in the European region finish primary education and are literate. However, just being able to read and write is not enough in today's world. Populations living in poverty and ethnic, linguistic and religious minorities, and children with disabilities have fewer educational opportunities and will be unable to move out of poverty.2