National Report on Follow-Up to the

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					Table of Contents

Abbreviations and Acronyms                                                                       4
Executive Summary                                                                                6
A. Introduction and Background                                                                  10
B. Process Established for the End-Decade Review                                                11
C. C. Action at the National and International Levels                                           13
D. Specific Actions for Child Survival, Protection and Development                              13
a) To disseminate and promote the earliest possible ratification of the Convention on the       13
   Rights of the Child and, thereafter, to promote its implementation and monitoring.
b) To combat childhood diseases through low-cost remedies and by strengthening primary          14
   health care and basic health services; to prioritise the prevention and treatment of AIDS;
   to provide universal access to safe drinking water and sanitary excreta disposal; and to
   control water-borne diseases.
c) To overcome malnutrition, including by ensuring household food security and by               18
   developing strategies that include employment and income-generating opportunities;
   dissemination of knowledge; and support to increased food production and distribution.
d) To enhance the status of girls and women and ensure their full access to health,             21
   nutrition, education, training, credit, extension, family planning, pre-natal, delivery,
   referral and other basic services
e) To ensure support for parents and other care-givers in nurturing and caring for              24
   children; to prevent separation of children from their families and, where such
   separation takes place, to ensure appropriate alternative family care or institutional
   placement.
f) To ensure priority for early childhood development; universal access to basic education;     25
   reduction of adult illiteracy; vocational training and preparation for work; and
   increased acquisition of knowledge, skills and values through all available channels.
g) To ensure special attention to children living under especially difficult circumstances;     29
   including by ending their exploitation through labour; and by combating drug, tobacco
   and alcohol abuse among young people.
h) To ensure special protection of children in armed conflict and to build a foundation for a   32
   peaceful world by promoting the values of peace, tolerance, understanding and dialogue.
i) To prevent the degradation of the environment by pursuing the World Summit goals, by         34
   inculcating respect for the natural environment, and by changing wasteful consumption
   patterns.
j) To address poverty and debt; mobilise development finance; halt the net transfer of          35
   resources from developing to developed countries; establish an equitable trading system;
   and ensure children are given priority in economic and social development.
E. Lessons Learnt and Future Action                                                             36
Statistical appendix                                                                            38




                                                -2-
Abbreviations and Acronyms

AFP            Acute Flaccid Paralysis
AIDS           Acquired Immunodeficiency Syndrome
ARI            Acute Respiratory Infections
BCG            Bacille Calmette-Guerin, vaccine for tuberculosis
BFHI           Baby-Friendly Hospital Initiative
CRC            Convention on the Rights of the Child
DPT            Diphtheria, Pertussis, Tetanus vaccine
ECD            Early Childhood Development
EPI            Expanded Programme on Immunization
EOC            Essential Obstetric Care
FRY            Federal Republic of Yugoslavia
FRY excl.      Federal Republic of Yugoslavia excluding Kosovo and Metohija
K&M
GDP            Gross Domestic Product
HIV            Human Immunodeficiency Virus
ICCIDD         International Council for Control of Iodine Deficiency Disorders
ICD – X        International Classification of Diseases – Tenth Revision
ICRC           International Committee of the Red Cross
IDD            Iodine Deficiency Disorders
IDP            Internally Displaced Persons
IEC            Information – Education – Communication campaign
IMCI           Integrated Management of Childhood Illnesses
IMR            Infant Mortality Rate
IUD            Intrauterine Device
K&M            Kosovo and Metohija, province in the FRY
KAP            Knowledge, Attitude, Practice study
LBW            Low Birth Weight
MCHC           Maternal and Child Health Care
MICS           Multiple Indicator Cluster Survey
MMR            Maternal Mortality Rate
MMR            Measles, Mumps, Rubella vaccine
NA             Not Available data
NCHS/WHO       US National Centre for Health Statistics/World Health Organization
               standard or reference population for nutritional status of children


                                          -3-
NGOs      Nongovernmental Organizations
NNT       Neonatal Tetanus
NPA       National Plan of Action for Children
OPV       Oral Polio Vaccine
ORT       Oral Rehydration Treatment
R + IDP   Refugees and Internally Displaced Persons
SD        Standard Deviation
SFRY      Socialistic Federal Republic of Yugoslavia (former Yugoslavia)
SWC       Social Welfare Centre
U5MR      Under-five Mortality Rate
UNHCR     United Nations High Commissioner for Refugees
UNICEF    United Nations Children‟s Fund
UNMIK     United Nations Mission in Kosovo
UNISCAL   UNICEF scale – weight measuring instrument
WHO       World Health Organization
WSC       World Summit for Children
YRC       Yugoslav Red Cross




                                   -4-
Executive Summary

The Socialist Federal Republic of Yugoslavia signed the 1990 World Summit for Children
Declaration, and committed itself to setting child welfare goals for the year 2000 and to
mobilise the necessary resources to achieve those goals. A National Plan of Action for the
Federal Republic of Yugoslavia was not elaborated until 1996, and then was not fully
implemented due to the economic crisis, which was a consequence of sanctions imposed by
the international community, a war environment, a large influx of refugees from the
Republics of former Yugoslavia, and other reasons. Progress toward the goals was reviewed
in 1996, and included a nation-wide household survey that helped to improve health and
nutrition programmes. This end-decade report is based on routine statistics and a battery of
specific surveys, including a follow-up nation-wide survey to the 1996 exercise, along with
extensive consultations with ministries, public institutes and representatives of civil society.

Of the 27 global goals, the country met 13 and did not meet 6 (8 were either not applicable
or had no indicators by which to monitor progress). Progress toward the goals was reversed
during years of economic sanctions, and due to the existence of the largest population of
refugees and internally displaced persons in Europe. There may have been further reversals
in the past two years that have not yet been registered in the data. Some negative trends
have already been registered, such as an increase in malnutrition. Reaching many of the
goals was possible given past investments in social welfare and targeted low-cost
interventions during the decade. Some of the global goals were not pertinent given the
country's level of development. At the same time, the realisation of a number of rights
defined in the Convention on the Rights of the Child has been substantially violated in the
course of relevant decade.

The end-decade review has highlighted a catalogue of specific demands for interventions in
health, education and protection. Many of these can be addressed in the context of ongoing
programmes and institutional reforms. They include:
        - reinforcement of immunisation services and the integrated management of
           childhood illnesses, with particular emphasis on improving the home
           management of illness;
        - HIV/AIDS, with emphasis on improving epidemiology, public awareness and
           prevention;
        - family planning, with attention to affordable modern methods of contraception
           and the particular needs of youth;
        - antenatal, delivery and postnatal services, to enable more continuity of care,
           continuous quality assessment and total quality management in maternities;
        - breastfeeding, to further raise exclusive breastfeeding rates and improve the
           baby-friendly aspects of maternity services;
        - monitoring nutritional status;
        - modernising the water and sanitation network, with attention to quality;
        - learning achievements. New pedagogical materials are needed, the curricula
           needs revision, and teaching methods might incorporate more active
           participation on the part of students;
        - a better integration of ethnic minorities into the educational system;
        - training social workers in the early detection of abuse and neglect, and giving
           more attention to prosecuting crimes;
        - a review of certain procedures of juvenile justice, to ensure that it is widely
           accessible and that the child's defence is independent and impartial;

                                              -5-
       -   targeting certain health and education interventions on child refugees and
           internally displaced children living in collective centres;
       -   disabled children, who need more home-based services, improved diagnosis,
           more schooling, and more opportunities for integration.
       -   a review of the policy and conditions of institutional placement of children in
           need of special protection

Underpinning many of these constraints is a lack of resources for the priority social sectors.
Reform, renewed economic growth and the normalisation of international relations are key
elements to generating the resources necessary. In general, access to services is good but
their quality must be raised. Adequate operating budgets are an important aspect of ensuring
quality, but there is also a general need to review how services are delivered. It would be
useful to have more emphasis on involving beneficiaries in decision-making processes, on
consulting children and parents about their views, and increasing children's participation.

Information systems will need to be adapted to provide better disaggregation and more
information about service quality and system efficiency. New indicators will be needed to
incorporate certain child protection issues. The whole should enable the monitoring of child
rights.

Reform and resources require political commitment. Mobilising commitment should be
integrated into a new round of setting goals. This might be done in a multinational
framework, to profit from lessons learned elsewhere and to identify areas that would benefit
from regional cooperation.




                                             -6-
SUMMARY

                        Description                    Achievement                    Remark
Goal 1:    Reduction of infant and under-five                Yes     IMR 12.0 (trendline prediction).
           mortality rate by one-third between                       U5MR 14.0 (trendline prediction).
           1990 and the year 2000
Goal 2:    Reduction of maternal mortality by half           No      MMR 7.3 (1996) - rare event, one of the
           between 1990 and the year 2000                            lowest in the region
Goal 3:    Reduction of severe and moderate                  NA      Data from 1990 non-available.
           malnutrition among under-five by half                     MICS 2000 data:
           between 1990 and the year 2000                            underweight 1.9; stunting 5.1; wasting 3.7
Goal 4:    Universal access to safe drinking water           Yes     98.4 percent of population use improved
                                                                     drinking water sources
Goal 5:    Universal access to sanitary means of             Yes     99.6 percent of population use improved
           excreta disposal                                          sanitary means of excreta disposal
Goal 6:    Universal access to basic education and           Yes     93.8% of children reaching grade five.
           achievement of primary education by at                    97.4% of children of primary school age
           least 80 per cent of primary school-age                   attending primary school.
           children, with emphasis on reducing
           the current disparities between boys
           and girls
Goal 7:    Reduction of the adult illiteracy rate to         NA      Literacy rate in 1991 for population aged
           at least half its 1990 level, with                        15+ was 92.4%.
           emphasis on female literacy
Goal 8:    Provide improved protection of                    NA      No indicators were specified
           children in especially difficult
           circumstances and tackle the root
           causes leading to such situations
Goal 9:    Special attention to the health and               Yes     U5MR of female children: 14.0 (1997);
           nutrition of the female child and to                      Underweight of female U5: 2.0%.
           pregnant and lactating women
Goal 10:   Access by all couples to information              No      Contraceptive prevalence 58.4%;
           and services to prevent pregnancies                       Adolescent fertility rate 28.0 (1997);
           that are too early, too closely spaced,                   Total fertility rate 1.74 (1997)
           too late or too many
Goal 11:   Access by all pregnant women to pre-              Yes     92.8% of births attended by skilled health
           natal care, trained attendants during                     personnel;
           childbirth and referral facilities for                    Basic essential obstetric care 4.1 per
           high-risk pregnancies and obstetric                       500,000 population;
           emergencies                                               Comprehensive essential obstetric care
                                                                     3.5 per 500,000 population
Goal 12:   Reduction of the low birth weight (less           Yes     5% of live births weigh below 2500 grams
           than 2.5 kg) rate to less than 10 per
           cent
Goal 13:   Reduction of iron deficiency anaemia              NA      Data from 1990 not available.
           in women by one third of the 1990                         26.7% of women aged 15-49 years
           levels                                                    anaemic (MICS 2000).
Goal 14:   Virtual elimination of iodine deficiency          Yes     73.2% of households consuming
           disorders                                                 adequately iodised salt.
                                                                     Median urinary iodine concentration is
                                                                     158 mcg/l (school aged children).
Goal 15:   Virtual elimination of vitamin A                  NA      VAD is not considered a public health
           deficiency and its consequences,                          problem in FRY.
           including blindness




                                                       -7-
                        Description                   Achievement                     Remark
Goal 16:   Empowerment of all women to breast-              No      Breastfeeding rates:
           fed their children exclusively for four                  Exclusively BF: 10.6;
           to six months and to continue                            Timely complementary feeding: 33.2%;
           breastfeeding, with complementary                        Continued BF (12-15 months): 20.8%;
           food, well into the second year                          Continued BF (12-15 months): 10.8%.
Goal 17:   Growth promotion and its regular                 Yes     Need to improve monitoring and use of
           monitoring to be institutionalised by                    results, and to standardise GM chart
           the end of the 1990s
Goal 18:   Dissemination of knowledge and                   NA
           supporting services to increase food
           production to ensure household food
           security
Goal 19:   Eradication of poliomyelitis by the year         No      Last (24) cases of polio registered in 1996.
           2000                                                     Surveillance system in place.
Goal 20:   Elimination of neonatal tetanus by               No      Last (3) cases in 1997.
           1995                                                     Surveillance system in place.
Goal 21:   Reduction by 95 per cent in measles              Yes     Last U5 deaths (3) due to the measles
           deaths and reduction by 90 per cent of                   registered in 1997.
           measles cases compared to pre-                           304 notified cases of measles in 1998.
           immunisation levels by 1995
Goal 22:   Maintenance of a high level of                   Yes     Vaccination coverage rates (%):
           immunisation coverage (at least 90 per                   BCG 98.0;
           cent of children under one year of age                   DPT3 94.9;
           by the year 2000) against diphtheria,                    OPV3 98.0;
           pertussis, tetanus, measles,                             MMR 90.1.
           poliomyelitis, tuberculosis and against
           tetanus for women of child-bearing age
Goal 23:   Reduction by 50 percent in the deaths            No      Under five deaths from diarrhoea decreased
           due to diarrhoea in children under the                   by 38.2%;
           age of five years and 25 per cent                        138 deaths from diarrhoea notified in 1997;
           reduction in the diarrhoea incidence                     2.3 episodes of diarrhoea per child annually;
           rate                                                     ORT use 97.9%.
Goal 24:   Reduction by one third in the deaths             Yes     Under five deaths from ARI decreased by
           due to acute respiratory infections in                   58.5%;
           children under five years                                189 deaths from ARI notified in 1997;
                                                                    96.7% of children were taken to an
                                                                    appropriate health provider.
Goal 25:   Elimination of guinea-worm                     Not
           (dracunculiasis) by the year 2000           applicable
Goal 26:   Expansion of early childhood                   Yes       17.0 percent in 1990;
           development activities, including                        31.4 percent of children aged 36-59 months
           appropriate low-cost family and                          are attending some form of organised early
           community-based interventions                            childhood education programme (MICS
                                                                    2000).
Goal 27:   Increased acquisition by individuals             NA      No indicator specified
           and families of the knowledge, skills
           and values required for better living




                                                      -8-
A. Introduction and Background

DELEGATION. The delegation of the former Yugoslavia (Socialis Federal Republic of Yugoslavia -
SFRY) to the World Summit for Children (WSC) was headed by Mr. Borisav Jovic, the co-President
of the SFRY. The government signatories of the WSC pledged to set and meet end-decade goals,
and to prepare a National Plan of Action (NPA) for Children.

FOLLOW-UP AND NPA. The Federal Commission for cooperation with UNICEF completed a
National Plan of Action in 1996, when it was adopted by the federal Government. The document
was submitted to all line ministries and local-level institutions in 1997 for implementation and
budget allocation. The document was ambitious and optimistic about future economic growth, and
required substantial resources for its implementation, not just from the government budget, but from
international donors as well. However, the economic crisis and the country‟s international isolation
became such that it was difficult to mobilise the funds necessary to implement the NPA. Finally, in
1999, at the peak of the Kosovo crisis and NATO bombing, it became clear that the NPA could
neither be implemented nor would it be possible to entirely respect the basic rights of children. As a
result, the Commission drafted a revised NPA, but it has not yet been considered by the government.

It is important to emphasise that many activities defined in the WSC declaration took place in
parallel to the NPA process. For example, in 1995 the Serbian government adopted the Decree on
Mother and Child Health Care (MCHC) for the entire territory of the Republic of Serbia (including
Kosovo and Metohija) while the Guidelines for the Decree‟s implementation were adopted in 1996.
By these two documents, a legal basis for MCHC was created, as well as precise rules for
implementation. More recently, health officials in the Republic of Montenegro have begun adopting
MCHC policy and implementing activities accordingly.

PERIODIC REVIEWS – THE MID-DECADE AND MID-TERM REVIEWS. The Government undertook
with UNICEF support the Multiple Indicator Cluster Survey (MICS), in order to determine progress
at mid-decade. The MICS was conducted in October 1996 and covered the whole territory of the
FRY. The results revealed that the majority of WSC goals might be achieved. These results were
discussed at the Federal Government-UNICEF mid-term review, and were accordingly incorporated
into subsequent government programmes. The mid-term review and discussion of mid-decade
results included some participation of representatives of civil society and of youth. Indeed, when
young people openly presented their view of the situation in the country, it literally shocked some
government counterparts. That was the first (and last) youth participation in a government session. It
was noted that there were obstacles to achieving the end-decade goals, including the country's
international isolation and poor economic performance. Some of the “side-effects” of the MICS
were of invaluable importance: capacity building, raising awareness of children‟s issues, assisting
programme planning and adjusting plans of action.

ARTICLE 44 REPORT. The government of the Socialist Federal Republic of Yugoslavia ratified the
Convention on the Rights of the Child (CRC) in December 1990, with one reservation (to the effect
that a child could be separated from his/her parent(s) in some instances without recourse to judicial
review).1 (This reservation has since been lifted). The government submitted its Initial Report to the
Committee on the CRC in September 1994.2 The Initial Report was first considered by the Pre-
Sessional Working Group in early 1995, and a list of issues was sent to the Yugoslav government,
along with an invitation to attend the Committee‟s full meeting to consider the Initial Report. The
Yugoslav government responded to the issues but declined the invitation, and the Committee
considered the Initial Report at its 269th meeting of 15 January, 1996 without the presence of
representatives of the government of the Federal Republic of Yugoslavia.

1
 Contrary to article 9 of the CRC.
2
 Committee on the Rights of the Child. Consideration of Reports Submitted by States Parties Under Article 44
of the Convention. Initial Report of States Parties due in 1993. Addendum. Federal Republic of Yugoslavia. 21
September 1994.

                                                    -9-
The Initial Report was a comprehensive review of all the articles of the CRC and their counterparts
in Yugoslav legislation, along with a practical discussion of how well the CRC was realised in the
FRY. Some elements of the review and discussion are referred to in the body of this report. The
government‟s position was generally characterised by two positions: that legislation was in overall
conformity with the CRC (with the one exception noted above), and that the country was suffering
from a series of profound political and economic crises that made it difficult to maintain previous
gains in the realisation of child rights and created new problems on a vast scale, particularly in the
area of protection. The economic collapse was already having a profound impact both on parental
and state capacities to provide for children and, as a result, on the welfare status of children; while
the violent disintegration of the SFRY had entailed the mass migration of over half a million
refugees into the territory of the FRY during the first half of the decade. The Initial Report made
repeated references to the negative impact of international sanctions upon child welfare.

The Committee on the CRC acknowledged that the country faced these difficulties.3 The Committee
also expressed concerns that: there was no independent system for monitoring child rights; article 2
(on non-discrimination) was not being implemented; certain mass media were broadcasting hostile
sentiments that might lead to the incitement of hatred against some ethnic and religious groups, and
that the lack of pluralism in the activities of the major organs of mass media was limiting the
freedoms of the child to receive information and of thought and conscience; there was a problem of
statelessness of refugees and of children born in other republics of the former Yugoslavia; there was
an overemphasis on the resort to and use of institutional care for children in need of assistance; there
appeared to be an increase in violent and aggressive behaviour among children; there were regional
and urban/rural disparities in health care provision; there was a discernible increase in the number of
children with mental disorders; education was becoming too expensive for poorer families, and that
pre-school was in decline; some refugee children were constrained from being reunified with their
families; applicants from certain regions were denied refugee status; families hosting refugees were
in a precarious material position; in the area of juvenile justice, social welfare agencies and services
enjoyed wide discretionary powers to the detriment of child rights, there was no mechanism to
register children‟s complaints concerning the juvenile justice system and to fully and impartially
investigate such complaints, and measures to protect the child‟s rights during investigation
procedures and the period of pre-trial detention were inadequate.

B. Process Established for the End-decade Review

The Yugoslav Commission for Cooperation with UNICEF started the process, asking relevant
ministries to prepare reports. The new federal government joined the process and reviewed the draft
report that was prepared by a team of experts. Certain elements of this report reflect the situation in
Kosovo and Metohija, while for some of the issues information was not available. This document
has been endorsed by the federal government.

The ministries, public institutes and civil society institutions conducted several surveys: Health
Behaviour of School-Age Children, Mobile Team Assessment Missions Reports, Iodine Deficiency
Disorders among School Children, Evaluation of HIV/AIDS Prevention, Public Opinion Poll on
Breastfeeding, Children‟s Views on the Implementation of Child Rights in Health and Education,
Ten Years of CRC Implementation in the FRY, A Comprehensive Analysis and Evaluation of
Education in FRY. Several of these studies were produced by local NGOs and independent
institutions, and with the active participation of children and youth.

The Multiple Indicator Cluster Survey (MICS) II was conducted in July-August 2000, on the
territory of the FRY, excluding Kosovo and Metohija. The survey was performed in a particularly
difficult situation, during sanctions and at the height of a political and economic crisis. Nevertheless

3
 Concluding Observations of the Committee on the Rights of the Child: Yugoslavia. 13/02/96.
CRC/C/15/Add.49.

                                                  - 10 -
the experience gained through MICS I helped UNICEF and the Institutes of Public Health to
complete the exercise. The data on other indicators were retrieved from a variety of sources, such as
the statistical and public health yearbooks and reports by other national and international
organisations. In November 1999, a Mid-Term Review of Government-UNICEF activities in
Montenegro was held in Podgorica, with the participation of Government and NGO partners, and
this contributed to the end-decade reporting process.


C. Action at the National and International Levels

THE NATIONAL LEVEL. The NPA process was described above. A discussion of national
programmes, plans and priorities can only be understood in the context of the war, poor economic
performance and international sanctions that characterised much of the 1990s. Military conflict
strongly influenced budget priorities, to the detriment of child protection. The economy performed
poorly as the country did not successfully make the transition to a market economy and laboured
under restrictions on trade and capital flows. This undermined state and household revenues, and
hence their care capacities for children. Resources were put under further strain by a large numbers
of refugees, and later of internally displaced persons. The non-government sector was not well
mobilised, as power was centralised and civil society was regarded with suspicion.

There is a well-developed statistical apparatus, which provided information on child indicators.
Where it proved inadequate, it was possible in some cases to undertake special surveys. Further
detail is provided in the Statistical Report in annex.

THE INTERNATIONAL LEVEL. Exposed to sanctions and isolation over the past decade, the FRY
was not an active player in the international arena, nor were international bodies active in the
country. State representatives were not invited to major international events and conferences (such
as Cairo, Beijing, Beijing Plus, Education for All conference in Dakar, the Stockholm conference on
the Stockholm Agenda for Action) nor was the state invited to sign a number of international treaties
(e.g. Landmine Ban Treaty). In return, international organisations were not welcome in the country –
from international media, to INGOs and UN agencies. Most of the UN organisations withdrew from
the country when the international sanctions were imposed. Those who remained, such as UNICEF
and UNHCR, though operational, were unable to establish full and creative cooperation with the
government.

D. Specific Actions for Child Survival, Protection and Development

As requested by the Executive Director of UNICEF on behalf of the UN Secretary-General, this
section provides brief assessments of progress achieved, major constraints faced and lessons learnt
with respect to the following ten actions from the Plan of Action for Implementing the World
Declaration on the Survival, Protection and Development of Children:4

a) to disseminate and promote the earliest possible ratification of the Convention on the Rights of
the Child and, thereafter, to promote its implementation and monitoring.

The SFRY ratified the UN Convention on the Rights of the Child (CRC) in December 1990.
Immediately thereafter, the country began to break apart. The government of the new country, the

4
  This section relies on many of the end-decade indicators. There are regional disparities in the data. In general,
child survival and development indicators are worse in Kosovo and Metohija than elsewhere in the country,
though it is not clear how much worse. Much of the population of that province did not participate in the last
census (1991), and there is some uncertainty surrounding official data generated there. Where possible, this
report complements routine data collection with independent household surveys (e.g. MICS 1, in 1996), but
here too there are difficulties. For example, the MICS 2 (2000) could not be conducted in Kosovo and
Metohija, precisely there where independent confirmation of routine data was most needed.

                                                      - 11 -
Federal Republic of Yugoslavia (FRY), established in 1992, respects the obligations of the former
Yugoslavia. The CRC became a part of the Constitution and the Federal Ministry of Justice
responsible for its implementation. The FRY Government submitted the first report to the
Committee on the Rights of the Child in 1994. In 1994, the Yugoslav Commission for
Cooperationwith UNICEF was established as a separate body within the Federal Government.
However, due to the political situation, implementation of the CRC was not a priority of the FRY
Government. Since a large number of the obligations entailed by the ratification of the CRC were
not fulfilled, some national NGOs, the “Friends of Children of Serbia” and the “Yugoslav Child
Rights Centre” in particular, undertook several initiatives: an initiative to establish an
Ombudsperson for Children; a campaign to incorporate the CRC into FRY legislation; a project
“Primer on Child Rights”; a project to have internally displaced children from Kosovo enrolled in
Serbian schools; a project to prevent abuse of children for political purposes; and so forth.

b) to combat childhood diseases through low-cost remedies and by strengthening primary health
care and basic health services; to prioritise the prevention and treatment of AIDS; to provide
universal access to safe drinking water and sanitary excreta disposal; and to control water-borne
diseases.

It is important to have some understanding of the health care context. Health legislation provides for
comprehensive care for children and women. It is financed through health fund contributions and
public budgets such that there should be universal access for all, regardless of economic status. The
state invested heavily in health infrastructure and personnel in the period following the second world
war, and there was already by 1990 an extensive network of health facilities. This can be seen at the
„primary health care‟ level, which has been in fact a comprehensive health facility incorporating
secondary-level services. For example, a child is seen at entry-level by a paediatrician, usually at a
medical establishment housing specialists to which the child can be referred if necessary.

This system has not worked well in practice in the 1990s. There are more doctors, particularly
specialists, than the country can afford; the plethora of complex entry-level institutions cannot be
sustained. Drugs are sourced inefficiently and are unaffordable. Health financing has been declining
constantly throughout the decade as the economy has contracted. Materials are commonly in short
supply, and equipment and buildings have not been maintained. Staff motivation has been affected,
the more so as salaries have subsided to poverty levels. Patients often must pay informally for
services and goods, particularly medication; this may have discouraged use, particularly among the
poor. Management of the system is over-centralised.

In Kosovo and Metohija, a parallel health system has been set up by the ethnic Albanian population.
Residents of the province sometimes use both the state and parallel systems, but there are no official
data on the latter.

There is an ongoing debate as to how to reform the health system to make it sustainable while
preserving principles of access and equity. The use of generic essential drugs, the rationalisation of
services, financial reform and decentralisation are all under study. It is by getting the economy to
grow again and resolving these debates that durable foundations will be laid for an overall
strengthening of primary health care and basic health services. Economic growth and civil stability
will also be important to the household, for its care capacities have been undermined too by the
decade‟s traumatic events. Despite these constraints, there have been primary health care
programmes that have been successfully developed as part of the drive to achieve WSC goals, and
these will need to be sustained. They include the Expanded Programme on Immunisation (EPI), the
integrated management of mother and child health care, and nutrition.




                                                - 12 -
VACCINATION. Vaccination coverage rates (according to the national immunisation schedule) have
graduated from the 80s to the 90s in this decade. 5 Trendline analysis suggests that the country as a
whole achieved coverage rates in the high 90s by 2000, though events in Kosovo-Metohija may have
had a negative end-decade impact on vaccination rates there. The MICS 2000 confirmed that in the
FRY (excl. K&M), coverage rates in the high 90s were indeed reached.

The greatest progress in coverage rates has been in Kosovo and Metohija, though in 1997 it was still
a region with relatively low rates (see Table 1). The progress has been due in part to the targeted
efforts of the national Expanded Programme on Immunisation (EPI) programme. UNICEF has
supported this programme by providing cold-chain equipment, disposables for immunisation,
vaccines, and vehicles for outreach activities. Particular attention has been given to improving the
surveillance system and rationalising vaccination practice, with a focus on safe-injections practices
and vaccination record-keeping. Community promotion of vaccination, the targeting of minority
groups and sub-national vaccination days have all been incorporated into the programme.

One administrative improvement of note has been the improved availability of vaccination cards
held by the family. In 1996, 37.1% of children had a vaccination card in their home at the time of the
survey. In 2000, following a distribution of individual cards, this proportion had risen to 75.8%.


     Table 1 Vaccination Coverage Rates (% of children vaccinated according to schedule)
                                      1990 1991 1992 1993 1994 1995 1996 1997                       2000
     BCG       National                                                         97.1                98.0
               Kosovo and Metohija                                              92.6                 NA
     DPT3      National               84.0 79.0 84.2 84.6 85.0 89.0 91.2 94.0                       94.9
               Kosovo and Metohija 64.8 55.7 70.1 71.5 79.3 78.0 81.7 89.3                           NA
     OPV3      National               80.7 80.5 84.5 82.6 84.4 89.6 91.1 94.0                       98.0
               Kosovo and Metohija 58.7 58.5 72.8 69.6 79.1 79.8 80.6 89.3                           NA
     MMR       National               83.0 75.5 81.8 84.9 80.8 86.0 90.1 91.9                       90.5
               Kosovo and Metohija 56.5 51.3 65.6 75.5 70.3 73.1 78.1 84.0                           NA
     Source: Federal Public Health Institute, Belgrade. BCG rates, and all 2000 results, are from MICS.
     NA = not available.


High coverage rates have translated into a low incidence of vaccine-preventable diseases, though
there is still room for improvement. There have been no cases of polio since 1996, in which year
there was an outbreak of imported polio, with 24 cases in Kosovo and Metohija. Since then, there
have been 3 sub-national immunisation days for polio, and an active acute flaccid paralysis
(AFP)/polio surveillance system has been established. During 1992-1997, there were 1 to 6 cases
annually of neonatal tetanus (NNT) (except for 1996, when there were none); again, most cases were
in Kosovo-Metohija. No cases were reported in 1998 (the last year for which data were reported),
though data were not available from Kosovo and Metohija. There are periodic outbreaks of measles,
every 3-4 years. There were 14 deaths in 1990, 4 in 1993, and 2 in 1997, the last year for which
there are national data; most cases (and in some years all) occur in Kosovo and Metohija. This is
partly the result of an uneven availability of the mumps-measles-rubella (MMR) vaccine; indeed,
this accounts for this antigen‟s relatively low nation-wide coverage rate. This is the only EPI vaccine
not produced in the FRY, and there have been supply difficulties on the international market.

The regional targeting of strategic activities will need to continue for the foreseeable future, as will
the general reinforcement of routine vaccination practices.


5
 Based on routine reporting data, except for the 1996 BCG, which is from MICS 1 (routine data are not
properly compiled for this antigen). The measles rate is based on the national schedule, i.e. vaccination
between the ages of 12-18 months. The other antigens are by the age of one.

                                                     - 13 -
ACUTE RESPIRATORY INFECTIONS (ARI) AND DIARRHOEAL DISEASES – THE INTEGRATED
MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI). This initiative is based on a WHO/UNICEF
programme, and was first adapted by the Mother and Child Health Care Institute of Serbia to cover
mother and child health care as a whole; more recently, the Children‟s Hospital in Podgorica has
adopted the IMCI initiative, and plans to implement its activities throughout the Republic of
Montenegro. The initiative combines strategies for the control and treatment of childhood diseases
and promotes practices to improve child health, in the following areas: ARI and diarrhoeal diseases
(which together constitute the main causes of preventable child morbidity and mortality),
immunisation, nutrition, child abuse, neurological disorders, acute urinary infections, safe
motherhood, family planning, sexually transmitted infections, hygiene, stress management and
psychosocial development. The programme was first implemented in Kosovo and Metohija in 1997,
in light of its higher infant/child mortality rates and the higher proportion of preventable diseases in
its infant/child mortality structure. It was thereafter extended throughout the Republic of Serbia.
More than 500 doctors have been trained, as well as 450 home-visiting nurses and 500 paediatric
nurses working in primary MCH care services. Trained staff were provided with the drugs,
equipment and consumables needed to carry out programme activities in the health centre. An
important component of this programme is to improve the home management of illness.

It has not been possible to evaluate the programme where most efforts were made (Kosovo and
Metohija), and elsewhere there has been rather little time to make an impact. One can note that the
under-five mortality rate for diarrhoeal diseases declined by 38.2% during the 1990-97 period; the
under-five mortality rate for ARI declined by 58.5% over the same period. There is a need to
improve the home management of illness. In 1996, for example, only 41.3% of children with
diarrhoea in the FRY received increased fluids and continued feeding, as per recommended practice.
In 2000, only 58% of mothers knew of at least two signs of illness for seeking care immediately.
Further, 11.6% of mothers reported administering antibiotics prior to seeking care, while 45.2%
report administering a cough syrup (some of which are not suitable for children). This programme
will be intensified, and an evaluation is foreseen in the near future.

HIV/AIDS The Programme for AIDS Prevention and Control in the FRY was adopted in 1995, at
the recommendation of the Federal AIDS Commission. In 1997, the Programme commissioned a
                                                                                     knowledge-
                                                                                        attitudes-
                                                                                practices (KAP)
                                                                                study (in one
                                                                                municipality of
                                                                                Belgrade),      to
                                                                                investigate the
                                                                                results of the
                                                                                Programme and
                                                                                to       establish
                                                                                         baseline
                                                                                indicators     for
                                                                                      monitoring
                                                                                progress. In the
                                                                                post-97 period,
the work of the Federal AIDS Commission has stagnated. However, public Institutes of Health, non-
governmental organisations (NGOs) and the media have undertaken information-education-
communication (IEC) campaigns, while the Institutes of Health and NGOs have also distributed
condoms and provided HIV testing.

New AIDS cases seem to have reached a plateau in the past 3-4 years (between 5-9 cases per 1
million inhabitants), and the AIDS mortality rate (AIDS deaths per 1 million inhabitants) has fallen
(Figure 1). However, it is not certain that all cases of HIV/AIDS and AIDS deaths are being properly
reported. The last case of AIDS reported in Kosovo-Metohija was in 1997, and it is not clear how

                                                 - 14 -
the situation has evolved since then. Further, it must be noted that there is no estimate of HIV
prevalence, indeed there is no systematic surveillance of HIV infection, and the incidence of AIDS
cases is subject to a long time lag as an indicator of the HIV/AIDS situation. Of the 860 AIDS cases
thus far reported in the country, the highest number has been among intravenous drug users (413),
followed by heterosexuals (164) and homosexuals/bisexuals (122). There have been 7 cases reported
thus far of mother-to-child transmission.

HIV/AIDS prevention faces several constraints on top of those to do with the operation of the
Federal AIDS Commission. The fear and insecurity engendered by the decade‟s events are
conducive to the development and worsening of harmful health behaviours, including behaviours
increasing the chance of HIV infection. Further, public understanding about HIV/AIDS is still far
from satisfactory. The MICS 2 included the first nation-wide survey of knowledge and attitudes
about HIV/AIDS. Most women (aged 15-49) had heard of AIDS (91.7% of respondents), but fully
one quarter did not know any of three ways to prevent HIV transmission,6 three quarters knew of at
least one way, while roughly only one fifth knew of three ways. Just under two thirds of women
knew that mothers can transmit HIV to their child. Misconceptions about AIDS are still common.
For example, only 38% of women (aged 15-49) believe (correctly) that AIDS can‟t be transmitted by
mosquito bites, while 62.7% believe (correctly) that a health-looking person can be infected. 44.9%
of the respondents knew of a place where one could be tested for HIV. Of those who had been
tested, 85.4% had been given the test results. Some discriminatory attitudes exist, with 29.1% of
respondents agreeing with at least one discriminatory statement.

These results suggest there is still ample room to improve knowledge, attitudes and practices. Health
information campaigns will need to be intensified and their geographical scope broadened. More
                                                                              needs to be understood about the
                   Figure 2 Source of Water, 2000 (excl. KM)                  drug culture and intravenous
           Other
                                                                              drug users, and other high-risk
            2.2%                                                              populations, such as commercial
                                                          Piped into dwelling sex workers. The lack of good
                                                                83.8%
                                                                              epidemiological       data      on
  Tubewell/borehole                                                           HIV/AIDS must be addressed.
     with pump
        4.4%
                                                                              The availability and affordability
                                                                              of condoms will need to be
                                                                              reviewed. AIDS victims need
          Protected dug well                                                  special support, not only in terms
                 6.8%
                                                                              of medical treatment, but to
        Piped into yard
              2.8%                                                            ensure that their rights are
                                                                              respected and they do not suffer
                                                                              social exclusion.

SAFE DRINKING WATER. The country has made progress in improving access to water, though
quality issues continue to be of concern. In 2000, 98.4% of the population (excl. K&M) had access
to safe drinking water, if one uses the commonly accepted definition of „safe‟ - sourced from a pipe,
a public tap, borehole/tubewell, protected well, protected spring or rainwater (Figure 2). One should
note that most water sources other than piped water are in close proximity to the household. There is
virtually none of the drudgery – for women or girls – mentioned in the Plan of Action for
Implementing the World Declaration.

Given the country‟s level of development, it is more suitable to use a restricted definition, namely
drinking water piped into the dwelling or yard/plot. In that case, the proportion of the population
using drinking water piped into the dwelling or yard/plot rose from 78.7% in 1991 to 86.6% in 2000.
(However, the 2000 figure excludes Kosovo and Metohija).

6
 Having only one faithful uninfected sex partner, using a condom during every act of sexual intercourse, and
abstaining from sex.

                                                    - 15 -
Despite these high access levels, this sector is in urgent need of rehabilitation. Although most of the
large water supply systems are functional (excepting Novi Sad), many of them are operating well
below capacity. The MICS 2000 found that 30% of urban households experienced sporadic
interruptions in their water supply, with 5-7% experiencing daily interruptions. Water quality is
unsatisfactory. The Institute of Public Health of Serbia found that in 1998/99 62% of systems tested
did not meet FRY microbiological standards, while 44% did not meet chemical-physical standards.
Levels of chemical-physical impurities have tended to increase since at least 1981.

The municipalities recording the poorest water quality often correspond to those hosting refugees
and IDPs, though it is not known whether this is due to prior problems with water infrastructure or to
increased demands on the system.

This sector has not received adequate investment and maintenance for many years. Roughly 30-50%
of network water is lost from the system due to leaks, and much of the network is made of asbestos-
concrete piping that needs replacing. Further, NATO bombing damaged chemical factories, causing
water and soil pollution (vinyl chloride monomers, naphtha, ammonia, hydrochloric acid, mercury,
liquid chlorine and dioxins).7 There was direct damage to water networks in Novi Sad, Mandjelos,
Sabac, Vladicin Han and Vranje, and to the water processing facilities at Jaros (near Sambor). The
country‟s main chlorine production factory in Krusevac was temporarily shut down during the
bombing, and the chlorine storage and repacking facilities in Pancevo were destroyed.

The management of this sector needs reforms and fresh funds. Prices are currently below costs,
revenue collection is low, and current regulations are not adequately implemented. A priority must
be placed on quality monitoring and maintenance.

There are also water quality problems for those using wells, which are most common in rural areas.
For example, a mid-decade study in Kosovo-Metohija, where wells are more common than
                                                                    elsewhere, found that 95% of
         Improved pit
                      Figure 3 Access to sanitary means of excreta  wells had microbiologically
            latrine            disposal, 2000 (excl. KM)            unsafe water.
                         Other
                  0.7%
                             0.5%
        Traditional pit                                                    In March 2000, a cyanide spill
           latrine
            10.5%                                                          in Romania crossed into the
                                                         Flush to sewage
                                                              57.2%        FRY, with a major impact in
                                                                           Vojvodina. The floods in July
                                                                           2000 contaminated wells and
                                                                           urban water systems alike
                                                                           throughout Central Serbia.
           Flush to septic                                                 Closer surveillance of water-
                tank
               31.1%                                                       borne    diseases    will    be
                                                                           necessary in affected areas, as
                                                                           will pre-emptive basic repairs
                                                                           and maintenance.

SANITARY EXCRETA DISPOSAL. Using the global definition of sanitary means of excreta disposal
(flush toilets connected to sewage systems or septic tanks, other flush toilets, improved pit latrines,
and traditional pit latrines), 99.6% of the FRY population (excl. K&M) lives in a household with
such means (Figure 3). A more suitable definition for the FRY is the proportion of the population
living in households with flush toilets linked to a sewage system or septic tank. Progress has been
made on this front throughout the 1990s. In 1991, 65.8% of the population (excl. K&M) lived in a
dwelling with such means of excreta disposal. In 1996, the figure was 77%, and in 2000, 88.3%


7
    WHO (August 1999), WHO Health Sector Assessment in FRY.

                                                - 16 -
(57.2% linked to a sewage system, 31.1% to a septic tank). The proportion of the population in
Kosovo and Metohija with access to such means in 1996 was 41.3%.

Future efforts will need to focus on those areas with low coverage. Further, many septic tanks have
been found to be leaky and poorly-positioned; when the household also relies on wellwater – which
is often the case when the household has a septic tank - there is a higher risk of exposure to
contaminated water.

One should note that for many municipalities, waste disposal is a significant problem. The MICS
2000 found that 54.7% of households had their garbage taken away by a public utility, 25.3%
disposed of it themselves at a public dump, 6.4% left it at an illegal dump, while the remainder
either burned (6.3%) or buried (0.3%) it, dumped it near the house (5.4%), or threw it in the river
(1.1%).

c) to overcome malnutrition, including by ensuring household food security and by developing
strategies that include employment and income-generating opportunities; dissemination of
knowledge; and support to increased food production and distribution.

The low birth weight (LBW) rate was 4.9% in 1994, the first year in which this data was officially
                                                                        reported. In 1998, it was 5%.
                 Figure 4 Weight-for-height, 2000                       There was little regional
                                                                        variation. In the FRY (excl.
      40                                                                K&M), the proportion of
      35                                        FRY (excl. K&M)         live births not weighed at
      30                                                                birth declined from 15.6% in
      25                                        Reference               1994 to 10.3% in 1999; thus
                                                population              the real LBW rate is perhaps
  %




      20
                                                                        at most 6-7%, which
      15                                      +2SD                      compares favourably to
      10          -2SD                                                  other European countries. A
       5                                                                low LBW reflects generally
       0                                                                good maternal health and
                                                                        intrauterine     development,
        -3.5 -2.5 -1.5 -0.5 0.5 1.5 2.5 3.5 4.5 5.5
                                                                        and it is well established that
                              standard deviations                       LBW is strongly associated,
                                                                        for example, with neonatal
                                                                        and infant mortality, and is a
strong predictor of childhood malnutrition. For it to have remained low in the FRY throughout the
latter half of the 1990s is an important public health achievement that no doubt helps to explain the
decade‟s generally good performance in child mortality and malnutrition.

The picture for protein-energy nutritional status, as measured by anthropometric indicators, is more
ambiguous (Figures 4 and 5). The main nutritional problem among children (aged under-five) is
obesity. For example, 8.2% of children aged under five are moderately obese while 6.1% are
severely obese (Figure 4).

In 1996, there was little or no malnutrition, and therefore no national goal was set for malnutrition
reduction for the year 2000. The national prevalences of malnutrition (using the three
anthropometric indicators) were at levels at or below what one finds in a reference population. The
only exception was stunting in Kosovo and Metohija (8.6%). The age structure of the malnutrition in
Kosovo and Metohija suggested that at least some of the causes underlying stunting had to do with
difficulties in the introduction of complementary foods and the case management of illness. These
were addressed in part with the National BF Programme and the IMCI initiative.



                                                - 17 -
                                                                           In 2000, the MICS found
                                                                           that    prevalences      of
                        Figure 5 Height-for-age                            malnutrition    had      all
       40                                           FRY (excl. K&M)        increased (though no data
       35                                                                  could be gathered in
       30                                           Reference              Kosovo and Metohija).
       25                                           population             The      prevalence      of
                                                                           moderate     and     severe
   %




       20
       15                                                                  underweight had risen
       10                                                                  from    0.5    to     1.9%.
        5                 -2SD                     +2SD                    Moderate     and     severe
        0                                                                  wasting had risen from 1.7
         -5.5 -4.5 -3.5 -2.5 -1.5 -0.5 0.5 1.5 2.5 3.5 4.5 5.5             to 3.7%, stunting from 2.1
                                                                           to 5.1%. The wasting and
                               standard deviations                         stunting are only 1.6-3
                                                                           percentage points higher
than what one finds in the reference population, and on a national level are of concern particularly if
the survey is registering a trend.

There were regional differences. The highest prevalence of moderate and severe stunting in the
country (excl. K&M) was in Montenegro (9%), while the lowest was in Vojvodina (3%). The rural
prevalence of malnutrition was generally higher than in urban areas. Higher levels of wasting and
stunting tended to be associated with lower levels of maternal education.

The increase in malnutrition may be due to the deteriorated economic and security situation in 2000,
as compared to 1996. Poorer households in particular had greater difficulty in ensuring adequate
food intake. Further, the health care capacities of households and public services had declined in this
period. There has also been an influx of children from Kosovo-Metohija, where higher prevalences
of malnutrition are common. Malnutrition, and stunting in particular, is of course associated with a
host of ills, including higher levels of child morbidity and mortality, poor school performance later
in life, and reduced energy levels. This situation will need to be monitored closely.

There is some institutionalised growth monitoring of children. Children are weighed at birth, and
should thereafter be weighed three times in the first year of life, and periodically thereafter. School-
age children should be weight-monitored at their check-up every two years. There is no nationally
standardised weight-monitoring chart, and the data that are kept in the child‟s medical file are not
systematically compiled and analysed for public health purposes. Growth monitoring has been
promoted at the community level through the distribution of leaflets to parents on infant feeding
with a growth monitoring chart and instructions on how and why to follow the child‟s growth
pattern.

Micronutrients. Iodine deficiency has historically been a significant public health problem in
Yugoslavia. In the early 50s, more than 650,000 persons suffered from endemic goitre in the
territory of the FRY and up to 3% of the total population from cretinism. In 1953, the iodisation of
all salt for human and animal consumption was mandated (at 10 mg I/kg salt), with a subsequent
reduction of goiter prevalence. An iodine deficiency disorders (IDD) study in 1990-92 nonetheless
found a continued prevalence of goiter in endemic regions. In 1992, the mandatory level of salt
iodine was raised to 20 (+/-4) mg I/kg salt.

In 1999, a nation-wide urinary iodine and goitre survey of school children in the Republic of Serbia
(excl. K&M) found no evidence of iodine deficiency. A similar survey is underway in the Republic
of Montenegro. There are no available data on the situation in Kosovo-Metohija.

The elimination of IDD in the Republic of Serbia (excl. K&M) has been achieved by iodising salt. It
is an important public health achievement, particularly in light of the difficulties this sector faced in

                                                 - 18 -
the 1990s. (The Republic was cut off from its main supply source, in Bosnia, in 1992). The largest
importer and producer currently employ adequate methods to ensure their salt is adequately iodised.
There are however a large number of smaller producers whose production is not adequately
controlled. The MICS 2000 found that 73.2% of households (excluding Kosovo and Metohija) were
consuming adequately iodised salt.8 There were regional variations, with Vojvodina having the
lowest household prevalence of adequately iodised salt consumption (62.8%).

Future efforts in this area will need to shift from eradication to sustaining achievements. There will
be a need for adequate regulation of imports and domestic production, some support to importers
and producers in their iodisation activities, and a continued monitoring of the iodine content in salt.

Anaemia. 29.4% of children aged under five have iron-deficiency anaemia. The proportion is more
pronounced at earlier ages, reflecting a poor introduction of the right kinds of complementary foods
and perhaps the mother‟s own anaemic state during pregnancy and breastfeeding. In light of this and
the level of maternal anaemia, a food fortification policy might be usefully examined.

Vitamin A deficiency is not considered a health problem.

BREAST-FEEDING. As breast-feeding is crucial to proper child nutrition, it was important to gather
information on this topic. The first-ever national breastfeeding survey was conducted in 1996 (MICS
                                                                              1). It found that
                                                                              breastfeeding       was
                                                                              widespread,          but
                                                                              exclusive breastfeeding
                                                                              was rare. In general,
                                                                              mothers         stopped
                                                                              breastfeeding too soon,
                                                                              and introduced other
                                                                              liquids             and
                                                                              complementary foods
                                                                              at too early an age
                                                                              (Figure 6). Since then,
                                                                              UNICEF has worked
                                                                              with health officials to
                                                                              launch the National
                                                                                        Breastfeeding
                                                                              Programme. This has
                                                                              included the BFHI
                                                                              (now operating in 24 of
                                                                              the     country‟s     69
maternities), extensive training of health personnel, and publicity campaigns to promote the virtues
of BF.

The MICS 2000 found that this Programme has helped to improve BF practices. In just four years,
the exclusive BF rate (among under-four months of age) has risen from 3.6% to 10.6% in the FRY
(excl. K&M);9 this rate is still very low by international standards. Further, the continued BF rate
(12-15 months) had risen from 15.6% to 20.8%, and the continued BF rate (20-34 months) from
7.1% to 10.8%. A geographically disaggregated analysis of the data showed that the improvement in
breastfeeding practices tracked the introduction of the BFHI in maternity wards. There is therefore a
need to reinforce and improve the initiative where it has already begun, extend the initiative to all
maternities, train the remaining health personnel, and continue with the information campaigns. The

8
 That is, salt measuring 15 parts per million or greater.
9
 Had the province of Kosovo-Metohija been included, the national average would perhaps have been 3 to 5
percentage points higher.

                                                  - 19 -
proper and timely introduction of complementary foods deserves particular attention, as the age
structure of malnutrition shows the period during which complementary foods are introduced to be a
particularly vulnerable one for some children.

d) To enhance the status of girls and women and ensure their full access to health, nutrition,
education, training, credit, extension, family planning, pre-natal, delivery, referral and other
basic services

THE STATUS OF GIRLS AND WOMEN. According to the FRY Constitution, all citizens are equal
regardless of sex. Women have special protection at work; universal right to health protection during
pregnancy; and mother and child have special protection. These Constitutional provisions represent
a good basis for equal treatment of women in the Yugoslav society. Seen from a long-term
perspective, Yugoslavia has made significant progress in the domain of female equality of women,
although there are indicators of unsatisfactory status of women in certain areas.

As signatory to the Convention on the Elimination of Discrimination Against Women, the Federal
Government established a Commission for the Improvement of the Status of Women in 1995, which,
in 1997, merged with the Commission for Cooperation with UNICEF. At the initiative of the
Yugoslav Commission for Cooperation with UNICEF and for Advancement of Women, the Federal
Government undertook to produce a National Plan of Action for Women in line with the conclusions
of the Beijing Declaration adopted at the World Conference on women in 1997. The draft NPA
focuses primarily on employment, health and health care, marriage and family, education, violence
against women and women as agents of changes. This document has not yet been considered by the
government.

The prolonged crises of the past decade have inevitably affected women. There has been a rise in
women‟s unemployment and, in part, a withdrawal of women from the labour market; there has been
a trend of re-traditionalisation of the role of women in the family and society (care of children, of
elderly members of the family, and of the household, while withdrawing from professional pursuits);
decrease in the share of women in the spheres of decision-making and management; reduction of
funds for the social sectors (children‟s allowance, family support institutions, allowances for
handicapped and disabled persons, etc.), which are of special importance for women; deterioration
of health conditions of women and decreased concern of women about their own health status.
Domestic violence is an issue of concern.

FULL ACCESS TO HEALTH, NUTRITION AND EDUCATION. Girls enjoy the same access as boys to
health, nutrition and education in the FRY, though there remain some gender biases in the use of
educational services in Kosovo and Metohija. There is no gender bias in the primary enrolment or
grade 5 achievement rates in the FRY (excl. K&M), though in Kosovo-Metohija in 1990,10 there
were five percentage points favouring boys‟ enrolment at the primary level. Nor is there any gender
bias at the secondary enrolment level (excl. K&M), while at the tertiary level, there are more female
students than male. There is no gender difference in child malnutrition, or in any of the health
coverage indicators available.

FAMILY PLANNING. Family planning services are provided at the primary care level in health
centres and at a secondary level in hospitals. The service includes physical examination, lab tests and
advice about appropriate contraceptive method. According to MICS 2000, 58.4% of women in the
FRY (excl. K&M) of child-bearing age who are married or in union practice some form of
contraception, of which the most common are the condom (17.5%), periodic abstinence (14.3%) and
withdrawal (11.3%). The adolescent fertility rate has steadily declined throughout the decade, from
41 in 1990 to 26 in 1998, while the total fertility rate decreased from 2.1 to 1.7 during the same
period. The fertility rates are kept this low in part due to abortions, of which there were 66.1 per 100
live births in 1996.

10
     When there were more reliable enrolment data.

                                                     - 20 -
The relatively low use of modern contraceptive method is due to abortion and certain constraints on
family planning services. Family planning services are in place, but they do not give rise to the use
of modern contraceptive methods, for several reasons. There are misconceptions concerning the
negative effects of modern contraceptive methods among both the general population and health
professionals, and thus adequate family planning counselling is not provided. Some modern methods
are considered inconvenient, or have been unaffordable or unavailable; some methods have high
perceived health risks. Gynaecologists are not preventive oriented. There are no cultural or
traditional barriers to abortion, which is easily available and inexpensive. FP counselling and sex
education for youth has not been given priority. Increased awareness of HIV/AIDS seems recently to
have had an impact on condom usage.

Improved health information and education on family planning for women of reproductive age are a
priority; this is particularly true for adolescents, for whom there are special considerations such as
confidentiality. It is also important to improve the availability and affordability of modern
contraceptive methods.

PRE-NATAL AND DELIVERY SERVICES. There is an extensive maternal health programme. It is
recommended that pregnant women visit the Maternal Care Service at least four times during
pregnancy, starting in the first trimester. While it is thought that this number of visits is achieved in
large urban centres, particularly Belgrade, there will be areas in the country where fewer maternal
visits are made.11

The mother is seen at the Maternal Care Service by a team of health professionals, including an
obstetrician/gynaecologist. A standard package of care exists, including pregnancy confirmation, lab
tests (e.g. for haemoglobin levels), blood pressure and weight monitoring (including weight gain
monitoring), pelvic circumference measurement, health behaviour counselling, and ultrasound. If the
haemoglobin levels prove to be deficient, the pregnant woman will be prescribed iron supplements.
In any case, one should note that it is recommended that women take folate supplements prior to
conception, and that they take iron and folic acid supplements after the third month of pregnancy.
Women categorised as at-risk should be followed by a specialised team. There are antenatal classes
available during the last month of pregnancy, which offer psycho-physical preparation for delivery.

These services deteriorated during the 1990s, particularly since 1993; while some of the services
have traditionally been weak, particularly health behaviour counselling. Lab tests are often not
conducted, equipment is not properly maintained, some services/materials can only be provided if
the patient pays, and the resultant difficult working conditions, compounded by inadequate salaries,
have undermined staff morale. These problems have led to increased recourse to private sector
services. There is a greater need to ensure continuity of care such that, for example, information on
the individual's care and condition generated antenatally is used at delivery, information generated
by a private sector service is used by the public sector service, and so forth. Given these constraints,
it is important to ensure that low-cost preventive measures are indeed being taken. The MICS 2, for
example, in the first exercise of its kind found that 26.7% of women (aged 15-49) suffered from
iron-deficiency anaemia.

Nearly all deliveries are attended by skilled health personnel, indeed by a team including an
obstetrician and a midwife. The proportion has consistently been in the high 90s, with the constant
exception of Kosovo-Metohija. There have been efforts in Kosovo-Metohija to provide more health
personnel, and as a result the proportion has risen somewhat throughout the decade from 76.7% in
1990 to 79.8% in 1998.



11
  The recording of visits to maternal care services is such that these data are difficult to compile from
published sources.

                                                      - 21 -
Of those deliveries attended by skilled health personnel, less than two per cent take place outside a
medical institution. The great majority of deliveries take place in one of the 74 maternity wards
across the FRY, while the remainder take place in one of the 12 outpatient maternity wards. Access
to essential obstetric care is good. There are 4.1 facilities providing basic essential obstetric care
(EOC) per 500,000 population in the FRY, and 3.5 facilities providing basic and comprehensive
EOC per 500,000. However, one must note that in some cases maternities are not adequately funded
to provide the medication and materials consumed during delivery, and families often must supply
these directly. One third of all deliveries take place in Baby-Friendly Hospital Initiative (BFHI)
maternities.

The general availability and quality of service are reflected in the maternal mortality ratio (MMR),
which has tended to decline throughout the decade. In 1990, the maternal mortality rate was 11
deaths per 100,000 live births. The national goal to reduce it by half was particularly ambitious as
only a handful of countries in the world have an MMR of 6 or less. Nonetheless, in spite of the
crises, the MMR in 1996 was 7.3 (the last year in which data for Kosovo and Metohija were
available).12 If one excludes Kosovo and Metohija from the calculation, the ratio declined from
12.02 in 1990 to 8.64 in 1999. There is room to improve obstetric care by introducing continuous
quality assessment and total quality management in maternities. In this context, more sensitive
indicators for monitoring the quality of MCH service should be developed.

HEALTH OUTCOMES – THE EVOLUTION OF INFANT/CHILD MORTALITY. Infant mortality declined
in the FRY by 37% from 26.2 to 16.5 during the 1990-97 period. Using this data, trendline analysis
suggests it should have reached 12 in 2000. The 1997 male infant mortality rate (IMR) was 4.7
higher than the female infant mortality rate (IMR), a spread greater than in 1990, when there was a
2.1 differential. There were substantial regional differences, ranging from 13.5 in the province of
Vojvodina to 21.7 in the province of Kosovo-Metohija. The U5MR was 16.5 in 1997 in the FRY,
and trendline analysis predicted it should have reached 14 in 2000. One must stress that vital
statistics registration in Kosovo-Metohija is unreliable, and the mortality rates may be higher than
what is reported here.13 If one excludes Kosovo and Metohija, then the IMR declined during the
1990-1999 period by 29.8% from 18.3 to 12.9, and trendline analysis suggested it should have
reached 11.8 in 2000. The male IMR was 2.5 higher than the female, an improvement on the 3.3
differential in 1990. The U5MR was 18.3 in 1990, and predicted to reach 13.4 in 2000.

These improvements are striking in light of the prolonged crises that have bedevilled the country
throughout the decade, and reflect no doubt prior investments in health and maternal education, a
generally good level of maternal nutrition, the relatively small number of births, the level of
antenatal, delivery and postnatal services, and the already high level of social development achieved
in 1990. The country was not however impervious to adversity, as the decline in the mortality rates
was not continuous. The infant and child mortality rates increased in 1992 and 1993, and again in
1996. Each of these years was associated with economic crisis and/or an influx of refugees. The
causes underlying these setbacks suggest that it is premature to conclude that the mortality rates will
indeed have declined again in 2000, as 1999-2000 were particularly poor years for children. There
was military conflict throughout the country in 1999, with direct damage to civilians and to public
health (12 health structures were completely destroyed) and civilian installations. There was a
decline in health services use during the bombing. For example, the total number of child (0-7 years)
visits to primary health care facilities in Belgrade in April 1999 was 45,408, as opposed to 104,756
visits in April 1998. Whereas women normally stay 5-7 days in the maternity ward with their infant
after delivery, during the bombing stays were reduced to 1-2 days. Health spending declined
significantly in 1999, and roughly 210 thousand IDPs were created. Together these problems seem
to have had an impact on mortality, as the number of deaths in January 2000 in the FRY (excluding

12
   The extreme variability of the Kosovo and Metohija data, and the presence of implausibly low points, in any
case suggest that the data from this province are not reliable.
13
   The registration of vital statistics is thought to be more reliable in the rest of the country. There is no
independent, i.e. survey-based, confirmation of the mortality rates for the FRY (excl. K&M).

                                                    - 22 -
Kosovo and Metohija) was 52% higher than in January 1999; the year-on-year increase for February
was 12%.

e) To ensure support for parents and other care-givers in nurturing and caring for children; to
prevent separation of children from their families and, where such separation takes place, to
ensure appropriate alternative family care or institutional placement.

SUPPORT FOR PARENTS AND OTHER CARE-GIVERS. The state has developed a child welfare system
which aims to provide all children with the same opportunities for development by providing
financial assistance, and by assisting families in bearing, protecting and educating children. Further,
the system aims to provide adequate remedial response to children who are deprived of parental
care, who are poor, and who have developmental problems. Health, early childhood development
(ECD), education and special protection services are addressed elsewhere in this report. The
allowances will be amplified here.

Child-care benefits include:
        - maternity leave and benefits (a Layette allowance - of 2,458 dinars - plus a year‟s paid
            leave or benefit if the mother was unemployed; up to five years if the child is disabled.
            The paid leave depends on the mother's salary, while the benefit is currently 737.40
            dinars per month);
        - child allowances, so long as the child is in school, until the age of 18 (the allowance is
            491.60 for the first child, 616.50 for the second, and 737.40 for the third child. The
            allowances are higher if the mother is single.);
        - kindergarten costs for a 3rd child in municipalities with negative population growth.
            (Kindergarten costs for the parent are roughly 500 dinars per child per month.)14

In general, financial benefits have been paid promptly in the Republic of Montenegro, but not in the
Republic of Serbia, where they are many months in arrears. The Serbian government has already
issued bonds to cover roughly 120 million DMs of arrears in child care benefits, with the first
instalment due in January 2001. Further, as at end-October 2000, there were 32.3 million DMs worth
of outstanding arrears.

Benefits do not accrue equally to each child. Per child benefits tend to increase up to and including
the third child, and then drop off or are cut altogether for each subsequent child. An exception is
made for areas with a negative population growth rate, in which case the per child benefit does not
decrease with the fourth and subsequent child. This linking of population and benefits policy has not
been particularly successful, as suggested by the falling total fertility rate.

A nurturing environment also requires social and economic stability, and in this respect the 1990s
have been difficult. Child refugees and IDPs have known little stability and most live in poverty (see
paragraph h). Further, as paragraph j amplifies, the economy has performed poorly in the 1990s,
with roughly 20% unemployment in 1999.

The creation of a nurturing environment for the child naturally requires more than state financial
assistance and economic stability. In particular, the home environment should promote psycho-
social and cognitive development, but relatively little has been done programmatically in this area.
There is a need to advise and assist parents on techniques for in-home stimulation and support,
particularly as national research has shown both that children arrive at grade 1 (primary) with a
relative school performance that is already determined by their socio-economic background, and that
this relative performance does not change throughout the primary cycle.


14
  The full cost is 2,632 per child per month, 80% of which is normally paid by the municipality and 20% by
the parent. Where there is a negative population growth rate, the Ministry of Family Welfare covers the full
cost.

                                                    - 23 -
SEPARATION. There are approximately 9,000 children who are currently deprived of parental care.15
The most common reason is abandonment (approximately 45% of current cases in 1999), followed
by parents who are not able to care for their child (approx. 30%), and parental death (20%). Children
taken from their parents by court order because of inadequate care account for roughly 5% of all
cases. (It should be kept in mind that separation from parents accounts for only a small portion of the
total number of cases of children in need that the Social Welfare Centres (SWCs) deal with. Most
cases are dealt with in the family context.)

The Social Welfare Centres are responsible for placing these children. The most common placement
is in a social welfare institution, followed by a foster family. There has been a fall in foster family
placements during the 1990s, caused by arrears in payments to foster families and by the general
economic decline which has materially affected foster families. Similarly, the annual number of
adoptions has declined, from 452 in 1991 to 262 in 1999.

There are three main categories of institutionalised children and youth: those in conflict with the
law, those who are disabled, and those (not included in the previous categories) who are deprived of
parental care. Institutions accommodating children have lacked adequate resources for many years,
and there is a need to carry out urgent repairs, and more generally to review the state of these
institutions and the welfare of the children they accommodate.

f) To ensure priority for early childhood development; universal access to basic education;
reduction of adult illiteracy; vocational training and preparation for work; and increased
acquisition of knowledge, skills and values through all available channels.

EARLY CHILDHOOD DEVELOPMENT. Early childhood development is institutionally fostered
through nurseries and kindergartens. The proportion of children aged 36-59 months who attended
some form of organised public early childhood education programme throughout the 1990s is
provided in Table 2. Attendance was negatively affected by the economic crisis in 1993, but has
since recovered and indeed improved, such that in 1999, the proportion was roughly one quarter.
Perhaps another 5% of this age group attends some kind of organised early childhood education
programme that is in the private or non-governmental sector.16 There is a slight gender bias in favour
of boys, participation rates are strongly associated with parental education (and hence perhaps with
household income), and urban rates are nearly four times higher than rural rates. There are no
reliable data for Kosovo and Metohija.

These participation rates increase with age. For example, in 1998/99, 74.7% of children in the FRY
(excl. K&M) aged 6 were enrolled in kindergarten.17 This is the year during which children normally
follow a programme to prepare for primary school, and the school day last three hours. This
programme is paid for by the state.

             Table 2 Proportion of children aged 36-59 months who are attending some form or
                              organised early childhood education programme
            1990     1991     1992      1993     1994    1995      1996    1997    1998      1999
              17      15.5     16.4      10.3     13.3    15.9     17.5      23     25.5      25.5
         Source: Federal Statistics Office. The figures for 1998 and 1998 exclude Kosovo and Metohija


Nurseries and kindergartens provide a wide range of services, in line with the varying needs of
children of different ages, children who spend full days or part days, and so forth. However, the

15
   Children 'deprived of parental care' include children whose parents have died or are incapacitated, and
children who have been abandoned or taken from their parents by court order. It does not include children who
are in an institution because they are disabled or have been in conflict with the law, unless they also fit into
one of the 'deprived of parental care' categories.
16
   MICS 2.
17
   If one adjusts the denominator to account for refugees, the rate is perhaps 5%-8% lower.

                                                        - 24 -
quality of services is declining due to budget cuts; the effects of resource constraints felt at the
primary level generally apply to the pre-primary level as well (see below). One should also note that
demand outstrips public-sector supply, as the number of children turned away annually has grown
from approximately 3,800 in 1990/91 to 11,200 in 1998/99 (out of a total enrolment of 178,000).18

UNIVERSAL ACCESS TO BASIC EDUCATION. Throughout the 1990s, children have enjoyed universal
access to a basic education, which in the FRY lasts 8 years and is both compulsory and free. In
general, the country enjoys a well-developed educational infrastructure, though it is poorly
maintained. There are a sufficient number of teachers, of whom 90% have a tertiary education
degree. The average student:teacher ratio declined from 18.3 in 1990/91 to 17.9 in 1995/96, and was
16.7 in 1998/99.

In light of the country‟s near-universal access at all Mother‟s educationMother‟s educations, the
country‟s main end-decade goals in basic education have been to universalise enrolment, ensure
universal completion of the primary cycle, and enhance the quality of teaching.

Enrolment rates are displayed in Table 3. The major enrolment issue has been in Kosovo and
Metohija, where ethnic Albanians withdrew their children from the public school system for most of
the decade (a parallel educational system was established); it has not been possible satisfactorily to
resolve this problem. It is not known how many children are receiving an education in that province,
nor of what quality.

There has been a tendency towards achieving universal enrolment, the province of Kosovo-Metohija
notwithstanding. The enrolment rates can be misleading, as the official statistics have not adjusted
the denominator to reflect the movement of refugees and IDPs into (and out of) the FRY. On the
other hand, the system‟s retention of pupils has increased throughout the decade. For example, the
proportion of children reaching grade five rose from 94.9% in 1990 to 96.3% in 1999. (The
evolution of drop-out rates – or indeed repetition rates – is not available, as these are not calculated
by the Ministries of Education). In any case, the MICS 2 found that in 2000, the net primary
attendance rate for boys was 98.2% and for girls was 96.6% (FRY excl. K&M).19

                              Table 3 Gross Primary Enrolment Rates (%)
                          1990 1991 1992 1993 1994 1995 1996                    1997 1998 1999
      FRY                  94.4 72.4 73.9 72.5 71.6 72.7 71.8                    70.7 98.9 97.5
      Kosovo-Metohija      92.4 11.6 11.3 10.9 10.8 10.9 10.7                    10.5 NA   NA
      Source: FSO. The data for 1998 and 1999 exclude Kosovo and Metohija.


Average primary expenditure per pupil in the FRY (excluding Kosovo and Metohija) declined
29.6% from 548 USD in 1990 to 386 in 1998. It will have fallen again since then, as GDP contracted
by 18% in 1999. Underfunding has led to a deterioration in schooling conditions, and in many
schools the quality of the learning environment is not satisfactory. Already in 1994, an official
schools inspection found that only half of all primary schools were in satisfactory condition. More
than half of the schools did not have libraries (many of which in any case were of a poor quality),
only one third had specially-equipped classrooms (e.g. laboratories), and there was less than one
computer per school. In 1999, 242 primary school facilities were damaged by the NATO bombing.

These problems have affected teacher morale, which has also suffered from inadequate
remuneration. In August 2000, no teacher‟s salary (from pre-primary to university level) was
sufficient to purchase the food and beverages consumption basket for a family of four. (See also
Figure 7). Indeed, no primary-level salary was sufficient to purchase even half of the minimum

18
   Again, excluding Kosovo and Metohija. This will understate real demand, as many will not apply, knowing
there is no chance for admission.
19
   The gender difference is not statistically significant.

                                                  - 25 -
consumption basket. As a result, teachers have not been able to provide the attention required to
their tasks, and this has affected teaching quality. Further, there have been strikes throughout the last
three academic years which will have further undermined learning. The 1998/99 school year was
also interrupted by the NATO bombing.

There are other system constraints. It is very centralised, and allows for little initiative and decision-
making at municipal and school levels. This limits the participation of parents and the community in
the running of the school, just as it does not allow for any initiative and participation of children in
decision-making or management (at any level of the educational system). The distribution of system
resources is not equal, with the south of the country and rural areas generally being less well-
endowed than elsewhere. The arrival of refugee and IDP children in the country will also have
created particular pressures on class sizes and teacher:pupil ratios, with Vojvodina, Southern Serbia
and Western Serbia having the most affected areas. The lack of disaggregated indicators makes it
difficult to identify disparities precisely.

There is provision for education in the language of national minorities. There were 40,520 children
enrolled in such schools in 1999, out of a total 817,283 children in the primary system; these figures
exclude Kosovo and Metohija. The educational achievement (i.e. the number of years of schooling
achieved, according to the 1991 census) of national minorities generally varies according to the
socioeconomic level of development of the region where they live. Hence national minorities in the
North (which is relatively well- developed) tend to be more educated than the average, while those
in the South (which is less developed) tend to be less educated. The Roma also live in relatively poor
regions, but face particular difficulties; their children are especially vulnerable. Roma educational
achievements are low in relation to the general population, reflecting relatively low school
enrolment rates. For example, 34.8% of Roma were illiterate in 1981, compared to 78.7% of the
total population in Serbia at that time. On the other hand, there are too many Roma children enrolled
in special schools who should be in regular primary schools. According to the Constitution, they are
an ethnic group rather than a national minority. As such they do not have a right to mother-tongue
instruction, and this will have a negative impact on the children's learning achievements in school.
The home environment is not particularly conducive to learning, as parents may not have strong
educational aspirations for their children, have limited ability to help the child in its own learning
efforts, and there is limited space. There are complex issues of discrimination and resistance to
integration involved with the Roma.

In general, teaching methods are too reliant upon a lecturing style of transmitting information, with
the student‟s role reduced to taking notes and memorising facts. This problem is related to the
curriculum being too extensive. Even those opportunities for hands-on participatory learning that the
student has traditionally enjoyed, such as were found in scientific laboratory work, have diminished
further for want of resources. There have been some pilot projects to introduce more student-
participatory learning methods in the classroom, and these have been taken up enthusiastically by
some teachers. However, there is a need to introduce a revised curriculum with modified teaching
methods that will enhance real learning acquisition through more active learning. Curriculum
changes will need to encompass those skills required for a country making the transition to a market
economy, and those skills needed for fostering a rights-based democratic society that is tolerant,
open and peaceful. There is equally a need to ensure continuous in-service training for teachers, and
to clarify opportunities for career development. Further, there is a need to address the changed
circumstances in the school environment, and how this affects teachers. For example, the setting of
school standards and teaching training were all geared to an environment that no longer exists.
Standards will thus need to be revised, and teachers will require guidance as to how best to teach in
this changed environment.

Parents pay some education costs directly. These include textbooks, student supplies, student
excursion fees, and some school charges to cover operating costs and repairs. Some parents feel
obliged to hire private tutors to cover essential material that was not covered adequately in class.
These charges can be onerous, particularly for poorer families.

                                                  - 26 -
All these constraints negatively affect the quality of teaching, of learning, and of the learning
environment. As a result, many children reach the end of the primary cycle without having mastered
the essential components of the primary education. If one uses the FRY primary curriculum as a
benchmark by which to measure the acquisition of a basic education, research in the late 1980s
already showed that less than half of primary school graduates had mastered fifty per cent of the
curriculum; the acquisition of knowledge in the sciences and mathematics was particularly poor. The
level of learning achievement will not have increased in the 1990s, given the constraints delineated
above. A study of learning achievements is currently being conducted.

The delinking of school marks, pass rates and the real acquisition of knowledge suggests also that
the quality of the teacher's monitoring of learning achievements needs to be improved. Monitoring
will need to be better linked to the child's real learning achievements, to the essential components of
the curriculum, and to opportunities for providing remedial attention. The quality of monitoring
performance has deteriorated during the decade, as teachers have had to deal with an increasingly
difficult teaching environment. This can be seen paradoxically in the steady improvement in pass
rates throughout the decade, and in the increasing proportion of children receiving the highest grade
possible.

Socio-economic disparities are expressed at the primary level in terms of marks and learning
achievements. The above-mentioned research showed that the socio-economic status of the child's
parents was a strong determinant of relative performance (as measured by marks and learning
achievements) right throughout the primary cycle.

Educational information systems need to be reviewed, so as to improve their programmatic utility.
Educational data are currently too focussed on aggregates, with insufficient attention to indicators of
the system's efficiency and quality, and of the system's distribution of resources. There is a need for
a more complete set of system indicators and for more disaggregation, and also to incorporate more
quality-related indicators, particularly in relation to learning achievements.

LITERACY. According to the 1991 census, 7.6% of the population aged 15+ (excl. K&M) was
illiterate (97% male and 87.9% female). However, one should note that Kosovo Albanians did not
participate in the census. The real national illiteracy rate was therefore higher. Further, in that in the
same year, 32.9% of the population (excl. K&M) had either not completed primary school or not
attended school at all, so this may be a more revealing indicator of functional illiteracy (again with
the proviso that including Kosovo Albanians would have made the percentages higher).

The regular education of the young, and the provision of second-chance schooling, are the main
means by which the government has addressed literacy. Given that illiteracy and lack of educational
attainment were heavily skewed with age, illiteracy will have fallen 1991 as the elderly have died
and the young have entered education at very high rates. Further, some 2,500-2,700 adults (of which
25-30% are women) attend the second-chance primary school each year, though it is not known with
what results. A new census in 2001 will provide an updated illiteracy rate.

VOCATIONAL TRAINING AND PREPARATION FOR WORK. There are two institutional options for
preparing the student for work: secondary vocational and tertiary. The 1998/99 gross secondary
enrolment rate was 74.5% (for the FRY excl. Kosovo and Metohija).20 Access to the secondary level
is not limited by place – there are adequate places for every primary graduate, should s/he wish to
carry on with their education – though there are entrance exams for some secondary institutions. Of
the three kinds of secondary schools, two are professional/vocational, while the third (general
secondary education) is preparatory for tertiary education.


20
 Though if one adjusts the denominator to account approximately for refugees and IDPs, the enrolment rate
was roughly 70%.

                                                  - 27 -
The educational system constraints outlined above also apply to the secondary level. Problems
pertaining to the quality of teaching and the learning environment are particularly acute in vocational
schools, as much of the didactic material is either outdated or in poor repair. Further, there is a need
to review the curriculum to ensure that it is well adapted to the new and emerging needs of the
FRY's changing economy. System efficiency is lower than at the primary level. For example, in
1997, 30% of those who enrolled in secondary school did not graduate.

Socio-economic disparities are more explicitly expressed at the secondary level, by relatively higher
drop-out rates and by choice/allocation of secondary school. Entry to the secondary level is very
high. For example, in 1998/99, 98.6% primary graduates entered secondary school.21 However,
children from poorer backgrounds tend to have higher drop-out rates. Further, such children tend to
go to secondary three-year vocational schools, rather than the general four-year secondary school
(and hence have lower university participation rates). This is the result of different aspirations and
expectations of schooling, but also of primary school and secondary school entrance exam results,
which determine access to particular secondary institutions.

Vocational schooling options are limited for those who did not complete primary education, or who
completed primary education and are now working. There is a second-chance school that teaches the
primary curriculum for those who did not complete the primary curriculum, but it is not vocational
in character. There is no non-formal system of continued education for those who are above the age
for regular school.

g) To ensure special attention to children living under especially difficult circumstances;
including by ending their exploitation through labour; and by combating drug, tobacco and
alcohol abuse among young people.

EXPLOITATION OF CHILDREN. In the Republic of Serbia, it is illegal to employ children under the
age of 15, and there are restrictions on the conditions of employment of children aged 16-18 (to
protect their welfare). However, there is no minimum age stipulated in the Republic of Montenegro.

Education has traditionally been the nation‟s best safeguard against child labour. The high net
primary school enrolment rate and labour regulatory authorities‟ reports suggest that there is very
little child labour (aged under 15). However, there are pockets of child labour, and in light of the
extent of the unregulated economy, there is no room here for complacency. The most conspicuous
example is children selling wares or begging in the street in large urban centres. This concerns Roma
children in particular, and there is a need for renewed effort better to provide these children with a
primary education.

Commercial sexual exploitation is illegal, though there have continued to exist isolated cases of
child prostitution throughout the 1990s. There is some need to reform the law pertaining to the use
of children in the production of pornography.22 There are reports that the country is used to transit
girls and women to points west for the purposes of sexual exploitation, and this is becoming an issue
of regional concern.

CHILD ABUSE AND NEGLECT. All persons and institutions dealing with children are mandated by
law to report cases of abuse and neglect to the Social Welfare Centre (SWC), though there are no
sanctions for failure to do so. There are no systematic data on this issue, and so it is difficult to
comment on how this has evolved in the 1990s. Indeed, SWCs have handled fewer cases of children
in need in the latter half of the decade, but this is rather the result of decreased capacities of the
SWCs to provide assistance. It is nonetheless acknowledged that the real incidence is higher than

21
   In the FRY excluding Kosovo and Metohija. This figure may overstate the case, as grade 8 graduate IDPs
came from Kosovo and Metohija and entered secondary school.
22
   While there are strict laws against selling pornography to children, there is no law against using children in
the production of pornographic material.

                                                      - 28 -
what is reported to SWCs, in general because such matters are considered private. Some SWC staff
have recently been trained to better detect this problem, and this has revealed a number of cases that
had previously gone undetected. More work needs to be done on this issue, including through the
courts, which have traditionally been reluctant to prosecute in this area.

There are no systematic data on street children. However, one can note that there are roughly 5,000
registrations of children at reception centres (to accommodate the child over night) each year.

CHILDREN IN CONFLICT WITH THE LAW. The rate of juvenile delinquency has tended to rise
throughout the 1990s, with a strong peak during the 1993-94 period, when the economy collapsed
and juvenile crimes against property rose sharply. In the last 3-4 years there has been an increase in
juvenile crimes against life and limb. These phenomena no doubt reflect difficulties in the
institutions that are important to the socialisation of children: the family, the school, the community
and the various welfare services.

There are many safeguards to protect the child‟s rights and interests throughout the administration of
juvenile justice. There are however some instances of legislation and practice that are not compliant
with the CRC and the Beijing rules. In general, the system is based on a social protective model as
opposed to the impartial and independent defence of the child. In practice, that entails an ambiguous
role for the Social Welfare Centre, which at one and the same time is called upon to defend the
child‟s interest and pronounce on the appropriate remedial measure. Further, the presence of defence
counsel for the accused is not always mandatory, but for lesser offences can be at the discretion of
the judge. There are similar instances of undue court discretion pertaining to the presence of the
child or his/her guardian during proceedings, and to the conduct of joint proceedings if the infraction
was committed along with an adult. There is no opportunity to hear cases in a specialised juvenile
court in smaller towns and rural areas.23 Consequently, if the child is heard before a juvenile court in
a larger town or city, it can be difficult for the child‟s parent or guardian to be continuously present
throughout the proceedings; while if the child is heard locally, due procedure might not be respected.
There is also a need to review the practice of granting the authority to Social Welfare Centres to
commit children aged under 14 to institutional accommodation, without recourse to the courts.

There are various sanctions open to the court, ranging from warnings to accommodation in open or
semi-open correctional institutions, culminating in incarceration in prison. Incarceration is rare. In
the Republic of Serbia, there are specialised juvenile detention centres, whereas in Montenegro there
are not, though juveniles are kept separate from adults.

DRUG, TOBACCO AND ALCOHOL ABUSE. There are no time series data for the decade, but it is clear
that there is much to be done to improve the health behaviours of adolescents. A 1999 survey of
children aged 11-15 in Belgrade and surrounding rural areas24 found that 23.3% smoke regularly,
with the practice increasing with age and being more common among girls. In Montenegro, 4% of
primary school students, and 20% of secondary school students, smoke, with no gender difference.
There was a higher prevalence of smoking among children who had either an older sibling or parents
who smoked. There are laws on smoking in public places and on the advertising of smoking, but
they are generally not implemented.

Among the Belgrade children, half of all boys aged 11-15 had tried alcohol, as had half of girls aged
15. Roughly 20% of the children had been drunk at least once, with the number of times increasing
with age such that 10% of those aged 15 reported having been drunk at least 4 times. In Montenegro,
9% of primary school children reported drinking regularly, while the figure for secondary school
students was 27.1%.



23
     Where there are too few cases to warrant the establishment of a juvenile court.
24
     Institute for Social Medicine, 2000. Health Behaviour of School Children in Serbia.

                                                       - 29 -
In the country as a whole, 4.8% of children aged 11-15 had tried marijuana (average age was 13.9
years when first tried), 1.5% had tried sniffing glue (12.9 years), 0.9% hashish (13.9 years), and
0.2% cocaine (13.4 years).25 Roughly one tenth of children reported that drugs could be sourced at
school, with the proportion being higher at secondary level.

Future actions in this area will need to encompass some integration of health behaviour messages
into the primary and secondary curricula, a review of the drugs situation in schools, as well as a
review and enforcement of legislation on tobacco and alcohol.

DISABLED CHILDREN. The Republican Constitutions guarantee special protection for disabled
persons, while there is legislation stipulating the educational and rehabilitative services that are to be
provided. These include assessment by a medical panel, the goals and content of training, class sizes
and duration, and so forth. The law enables children to be integrated into mainstream education,
where possible. There are also pre-school programmes that should last 3-5 hours daily. The disabled
child also has special entitlements to social benefits, which include material support, assistance for
the carer, training benefits, and, if necessary, placement in an institution or another family. There are
approximately 10,000 disabled children on the list of social protection beneficiaries. There is no
accurate estimate of the total number of disabled children; the lack of adequate services and stigma
can lead in some cases to parents not declaring their child's difficulties.

The provisions outlined above are not always realised in practice, and there is room to improve
policy and practice, particularly in terms of diagnosis, treatment, and education.26 In some cases, the
disabled child is misdiagnosed, often at too early an age, and then receives inappropriate treatment.
In other cases, the child is diagnosed at the age of five or six, which for some disabilities is an age
well beyond the optimal period for initiating remedial therapy. Earlier diagnosis will have to go hand
in hand with earlier treatment, which is also lacking. Rehabilitation therapies are more commonly
provided for children of primary-school age, though there are disparities in the provision of services;
children with multiple disabilities, living primarily in rural or undeveloped regions, are not
adequately covered. All services suffer from a lack of adequate pedagogical materials.

Rehabilitation institutions are specialised according to disability, and provide a range of in- and out-
patient services. There are several problems with in-patient services: inadequate resources to
maintain nutritional and hygiene standards and to provide proper therapy, children grouped together
whose mental abilities are too disparate, and stays often prolonged beyond the required time as
family conditions do not permit a return.27 Caring services provided by staff and working conditions
should be reviewed, as should recourse to institutionalisation. It is nonetheless important to keep in
mind two factors with respect to institutionalisation. First, there are few decentralised resources
available for dealing with handicapped children; parents who want professional care for their
children must resort to the few accommodation institutions specialised in disability, which are
necessarily geographically inaccessible for much of the population. (For example, there are three
such institutions in the Republic of Serbia, each accommodating several hundred children). Second,
there is a stigma attached to disability, and in some cases a consequent reluctance to keep children in
the home.

Pre-primary enrolment of disabled children still remains the exception, rather than the rule, and other
pre-school interventions, including home visits by nurses and rehabilitation therapies in specialised
clinics, are rarely provided. There is a network of special schools for the education of disabled
children. (The constraints outlined above in the section on education also apply to these special
schools). However, primary enrolment rates for disabled children could be improved, particularly in
those areas where there is poor access to such schools. There is little support for home-based
remedial and educational programmes.

25
   These data are derived from consumption surveys which rely on individual reports about behaviour.
26
   See Initial Report, para. 235.
27
   Initial Report, para. 240.

                                                   - 30 -
There is a wide range of problems surrounding access and integration. Participation rates in the
regular schooling system are constrained by inadequate school facilities and proper teacher training.
The employment results of those who do complete their education are unsatisfactory. More
generally, physical access to buildings and transport facilities is limited. There remain widespread
prejudices surrounding disability, and these also serve to hinder integration.

Social protection benefits are in substantial arrears in Serbia (though up-to-date in Montenegro).

Many of these problems have been recognised since at least the first half of the 1990s, but as yet
have not been solved. Indeed for many children the situation is worse now than in the past, as budget
cuts have entailed a shorter supply of services and specialised aids. Children of poor families will be
in a particularly difficult situation. Overcoming these constraints will require new policies, fresh
funds, and education campaigns combined with more decentralised and in-home support.

A GENERAL NOTE ON SOCIAL WELFARE CENTRES is in order, given their broad role in protecting
children. SWCs have a difficult working environment. Budgets have been cut, leaving social
workers underpaid and operating budgets inadequate. There have been numerous complaints about
staff „burn-out‟. It is also recognised that social workers require more training in modern early
detection and prevention methods, and in rights-based child-oriented interventions. More generally,
one can note that the number of child beneficiaries of the social welfare system is lower now than at
the beginning of the 1990s: 46.2 children per 1,000 (children aged under 18) in 1991 and 40.9 in
1998. This is party the result of a tightening of benefits eligibility criteria.28

h) To ensure special protection of children in armed conflict and to build a foundation for a
peaceful world by promoting the values of peace, tolerance, understanding and dialogue.

The 1990s have been an unmitigated disaster for children in situations resulting from armed conflict.
When the WSC declaration was signed, there was a negligible number of child refugees and
internally displaced persons in Yugoslavia, and child victims of armed conflict were hardly an issue.
By 1994, there were approximately 470,000 registered refugees.29 In 1996, there were roughly
646,000 registered refugees, of which 160,755 were children. As at end-April 2000, there were
218,129 IDPs registered, of which 81,984 were children. Together, these persons constitute roughly
10% of the FRY (excl. Kosovo and Metohija) population, and in absolute terms are the largest such
population in any European country.

In law, no male citizen can be recruited into the armed forces before the year in which he turns 18.
There have nonetheless been some reports of children under the age of 18 being unofficial
combatants during the Kosovo conflict.

Children who were displaced, either internally or as refugees, were deprived of many rights during
transit, and these could not be adequately rectified until their situation was stabilised. Further, many
of these children suffered trauma in the process of becoming refugees or internally displaced. For
example, mid-decade research found that roughly one third of refugees „were exposed to stresses of
war.‟30 Of those exposed to severe war trauma, 62% exhibited displayed symptoms of mental
suffering and 35% were in need of professional psychiatric support. In a recent survey of refugees
and IDPs, half reported that members of their family had been seriously psychologically affected by
their situation.31


28
   The fall in 1998 was mainly due however to the non-availability of data for the province of Kosovo and
Methohija.
29
   Initial Report to the Committee on the Rights of the Child, FRY, September 1994.
30
   UNICEF, Situation Analysis, 1998.
31
   IFRC/ICRC/YRC, FRY: IDP‟s and Refugee Living Conditions, April/May 2000, p. 20.

                                                    - 31 -
Special legislation was passed in 1992 to enable refugees to benefit from the country‟s social
services. In general, these various legal provisions state that refugees, including child refugees, will
be provided with temporary accommodation, relief aid in the form of food, comprehensive health
care, material and other aid. They have a right to work and, if of school-age, to an education and
various kinds of educational assistance. Disabled children (and university students up to the age of
26) are entitled to special care and rehabilitation. Refugee children with developmental disorders are
entitled to a place in a pre-school. Mothers with small children are entitled to maternity benefits.

Child refugees who are separated from their family are granted the same care as any other child
deprived of its family, as stipulated in the Law on Social Welfare and Provisions of Social Security.
The FRY authorities, through the Social Welfare Centres and the Republican Commissariat for
Refugees, cooperate with the Yugoslav Red Cross(YRC) and the International Committee of the Red
Cross in tracing the parents of refugee children, with an emphasis on unaccompanied children under
16.32 In some cases, children have become separated from one parent as a result of a marital dispute,
and the lack of official agreements between the FRY and other countries formerly part of the SFRY
has prevented a legal settlement of custody and access. This same problem continues to make it
difficult in some cases to enforce child-support payments.


      Table 4 Various Child Welfare Indicators - National Average (excl. K&M) vs.
                   R+IDP Children Living in Collective Centres, 2000
                                                                                                           All          R+IDP
      Stunted (moderate and severe) (%)                                                                           5.1      17.2
      Wasted (moderate and severe) (%)                                                                            3.7         8
      Annual number of episodes of ARI                                                                            0.7       1.6
      Attending some form of organised early childhood education programme (%)                                   31.4      20.1
      Net primary attendance (%)                                                                                 97.4     92.3
      Source: MICS 2. Note that the definition of ARI was very restrictive; hence the low annual number.


Internally displaced persons are still citizens, and as such enjoy the same social benefits and legal
protection as any other citizen of the FYR.

Organisations such as the Red Cross and the UNHCR also work with the public authorities to
provide assistance, particularly in terms of food aid and hygiene packs. For example, in 2000, 84%
of the R+IDP families reported receiving some food aid within the previous three months; 75%
received hygiene parcels; 38% clothes and shoes; 14% medicine and health care 12.5%; while 9%
received some humanitarian financial assistance. 13% reported receiving no humanitarian aid at all.
Further, aid agencies such as UNICEF have targeted their assistance to schools and health facilities
on municipalities with large numbers of refugees and IDPs (R+IDPs).

Various efforts have been made to address the psycho-social needs of children exposed to the
traumas of war. The Mental Health Institute of Belgrade set up a mobile task force of experts in
mental health in 1991, and visited mothers and children considered to be at particular risk. Further,
3,000 health workers and their associates attended one-day seminars on dealing with mental health
problems. More recently (in 2000), refugees and IDPs reported that 94% of those who had sought
help for psychological problems received it (though only one quarter of those reporting
psychological problems had indeed sought help).33

It will be clear from the socio-economic and political context provided earlier in this report that the
state is not able in practice to deliver all the benefits mentioned above. Where health and educational

32
     See Initial Report to the Committee on the Rights of the Child, FRY, September 1994, paragraph 357.
33
     IFRC/ICRC/YRC, FRY: IDP‟s and Refugee Living Conditions, April/May 2000

                                                                  - 32 -
services have been compromised generally, it will also affect refugees and internally displaced
persons. The arrears in social benefits that have currently accumulated in Serbia will equally affect
refugees and IDPs. Further, despite the in-kind material assistance provided to refugees and IDPs by
international organisations working with public authorities, the overall socio-economic context is
such that refugees and IDPs are still living in difficult circumstances, and this will naturally
constrain their efforts to help themselves. In 2000, R+IDP household incomes were broadly similar
to the poorest 40% of the population, though their incomes are generally less secure.

31% of refugee and IDP households in Serbia are in collective centres, with 42% in Montenegro. 34
A comparison of different welfare indicators for the R+IDP children (under-five) living in collective
centres with the general (excl. K&M) child population in 2000 suggested that in many ways, the
R+IDP children were worse off: they were not as well vaccinated, they suffered more illness and
malnutrition, and were less likely to attend school, whether at the pre-primary or primary level
(Table 4). It is not known whether this R+IDP profile is characteristic solely of this sub-group of
society, or whether it is also characteristic of the poor in general. The government has previously
reported a higher prevalence of emotional suffering among children living in collective
accommodation centres (than in private accommodation).35

PROMOTING THE VALUES OF PEACE, TOLERANCE, UNDERSTANDING AND DIALOGUE. There have
been projects to publicise the CRC and to support community activities that raise awareness of,
monitor and promote child rights. However, in most important respects, the previous government did
not work to build a foundation for a peaceful world by promoting the values of peace, tolerance,
understanding and dialogue. It was overwhelmingly a decade of conflict, in which the past
government was involved with wars both at home and abroad, and did not tolerate well political
dissent or public criticism. The government-controlled mass media were not notably tolerant, and
were often used to attack opponents of the regime. Civil liberties were not respected, including those
of minors.

i) To prevent the degradation of the environment by pursuing the World Summit goals, by
inculcating respect for the natural environment, and by changing wasteful consumption patterns.

There is a policy, legal and institutional framework in place for the environment that is broadly
similar to other countries in the region. There is an environmental policy statement and the
constitution acknowledges the right to a healthy environment. The government has signed 52
international treaties or conventions on the environment. There are numerous regulatory bodies for

34
  IFRC/ICRC/YRC, FRY: IDP‟s and Refugee Living Conditions, April/May 2000
35
  Initial Report to the Committee on the Rights of the Child, FRY, September 1994, paragraph 362. A 1998
survey found no indication of protein-energy deficiency among child refugees living in collective centres,
though roughly 10% of children were overweight. (WHO/UNHCR/Institute of Public Health of
Montenegro/Institute of Public Health of Serbia, 1998. The Health and Nutrition of the Refugee Population in
the FRY.) This suggested that aid measures, along with the refugee families own efforts, were proving
adequate in this respect. However, there were food quality problems, manifest as mild anaemia among
approximately 40% of women and 40% of children aged under 5. Less than 1% of children aged 9.6 to 18
years had a palpable thyroid. The MICS 2 (2000) found that 7.8% of refugee and internally displaced (R+IDP)
children living in collective centres aged under 5 were wasted (5%-10.6%, 95% C.I.) and 17.2% were stunted
(13.3%-21.1%, 95% C.I.). This was significantly higher than the national averages (excluding Kosovo and
Metohija) for wasting (3.7%: 2.6%-4.8%, 95% C.I.) and stunting (5.1%: 3.8%-6.4%, 95% C.I.). There can be
several reasons for the apparent increase in malnutrition among children living in collective centres since
1998. The two sample populations of the two surveys are not the same, in many senses. For example, the 2000
sample included IDPs, whereas the 1998 sample did not. This different provenance may be important (i.e.
from Kosovo-Metohija, rather than abroad), because it is known that children in Kosovo-Metohija have worse
child welfare indicators generally. So it may be that the increase simply reflects a change in the constitution of
the population, with the new arrivals bringing with them a status and practices that have changed the apparent
welfare status of the group as a whole. Also, the economy has deteriorated since 1998, and the worsened
nutritional status and relatively poorer health status may reflect a real deterioration in food intake and
household care capacities.

                                                      - 33 -
monitoring the quality of the environment. In general, regulatory authority monitoring capacities
have been undermined by the state's revenue crisis over the past ten years and by the country's
international isolation.

Consumption has fallen during the 1990s as a result of the general economic crisis. However, many
industrial and other economic activities remain inefficient and environmentally hazardous, and the
reduced economic activity of the past decade has not allowed for new investment in environmental
protection. Air pollution is concentrated in urban and industrial areas. As a result of industrial
pollution, most rivers have been downgraded over the past 30 years using the 1968 four-class quality
system, though some of this pollution flows in with the Danube. The chemical industry and primary
metallurgy account for most waste generated, with an estimated 225 thousand tonnes of hazardous
waste being produced annually. There are inadequate treatment or storage facilities for hazardous
waste. There are areas of particular environmental concern such as the lead and zinc mines and
industry in Kosovska-Mitrovica and the lignite mines and industry in Obilic.

The Kosovo conflict created special environmental problems. There was damage to water and
sanitation systems, and to chlorine-holding plants, and this led to an increase in water contamination
and a reduction in water supply. Chemical factories were damaged; as a result, pollutants were
released into the surrounding soil and water and will have entered the food chain. Damage to petrol
processing plants affected fuel availability, with a consequent negative impact on sanitation services
such as refuse collection. The environmental and health impact of depleted uranium shells used
needs to be assessed. Numerous land-mines were laid and need to be cleared.

j) To address poverty and debt; mobilise development finance; halt the net transfer of resources
from developing to developed countries; establish an equitable trading system; and ensure
children are given priority in economic and social development.




The economy did not perform well in the 1990s, and this had a profound impact on the care
capacities of both the state and the family. Spending in the social sectors is closely linked to
economic output, and GDP has been falling throughout the decade; per capita GDP in 2000 was
estimated to be 43.1% lower than in 1990. The proportion of the population with an income less than
the cost of a food and drink expenditures basket normatively defined by the Federal Statistics ranged




                                                - 34 -
from 19%-33% during the 1991-1998 period.36 The number of unemployed has increased in recent
years, and the unemployment rate in 1999 was roughly 20%; unemployment rates for young people
are much higher.

Allowances are paid to poor families, though eligibility criteria have been tightened during the
decade to reduce the number of beneficiaries; delays in payment further served to discourage
individuals from applying for a poverty allowance. As a result, in 1990, there were 10.4 adults per
1,000 population receiving a poverty allowance, while in 1998, there were 7. No payments were
made over a 14 month period in 1997-98; payments were made in 1999 until July, but since then
further substantial arrears have accumulated.

The country is very indebted, and no foreign debt payments have been made in several years.
Substantial interest arrears continue to mount. The country faced sanctions from the international
community throughout most of the decade, making it impossible to mobilise development finance.
The country has recently regained its membership in the IMF, and negotiations are underway with
the World Bank. Financial agreements with these and other partners are of the utmost importance.
The new government must take advantage of its fresh mandate to implement reforms with due
speed, and this will require substantial resources. Special arrangements will need to be made to
ensure that children receive the right priority in the allocation of resources.

E. Lessons Learnt and Future Action

The ten years following the World Summit for Children were characterised by economic difficulty,
international isolation and military conflict. Progress towards the goals was by no means constant, as
the rise in child mortality rates in difficult years testified - yet most of the goals were achieved. This
reflects the power of prior social investments. In general, women are relatively well educated, are of
good nutritional status, have few children, and are provided the opportunity by the state to care for
the infant. There is an extensive set of social services in health, education and protection. Despite the
erosion of their funding, they were still sufficiently professional and motivated that initiatives had a
rapid impact, provided they were well-focussed and low-cost; witness for example the eradication of
iodine deficiency or the achievement of high rates of vaccination coverage.

However, it is clear that for the social services to be truly effective, they require fresh investment
and adequate operating budgets. In a word, they must be reformed. More resources need to be freed
up for primary health care, which must be redefined, rationalised and more oriented towards
prevention and the changed structure of mortality; and for education and protection. Reforms must
naturally be in line with available resources, and incorporate a top priority for the primary levels and
children. Everywhere the watchword must be quality. Access to social services is generally high, but
quality is our next challenge: quality of drinking water and sanitation facilities, quality of the
learning environment at school, quality of health and protection services. Improving and monitoring
the quality of services in particular will require special attention to the quality of relations between
user and service-provider, and in some cases to involving beneficiaries in decision-making
processes. Many quality issues involve regulations and laws. These will need to be more rigorously
implemented in the future.

End-decade progress could not be measured in Kosovo and Metohija. Good progress had been made
in some areas of social welfare up to 1997, the result of past targeted efforts and investments. Future
efforts will need to continue such targeting.

The issues of child protection need special attention. They cover a wide range of problems that
children face: abuse and neglect, conflict with the law, separation from their parents, exploitation,

36
  The basket of 65 food and drink goods was initially designed in 1987 for a household of two adults and two
children, and comprised those goods considered to constitute a healthy consumption basket. It does not include
any non-food or non-drink goods.

                                                    - 35 -
disability and so forth. These all need to be reviewed from a child rights perspective, with particular
emphasis on the marginalised.

The use of special surveys, such as the MICS or the iodine deficiency surveys, has enriched
traditional information sources. Such exercises will be needed again in the future. Routine
information systems will need to be reviewed to ensure that they provide the kind of data required to
monitor quality, and that they are sufficiently disaggregated. Disaggregation should naturally
encompass gender, minorities and socio-economic status, as well as the regions. The data that were
not available for the end-decade goals - as was generally the case for protection - will need to be
gathered.

The assignment of a high priority to children necessarily entails a political commitment. This should
be linked to a new round of goals setting. Some of the global goals of the WSC have proved
pertinent to the FRY, and have helped to mobilise resources and efforts in improving child welfare.
Other goals, however, were less well-adapted to the FRY. Future goals will have to take into account
national development realities and priorities. There are particular needs for more qualitative
indicators, for more disaggregation in order better to identify disparities, and for indicators covering
the gamut of children in special need of protection. More emphasis should be placed on setting goals
for process, rather than impact, indicators, as they are more susceptible to programmatic influence.
Multinational consultation would be useful, particularly in light of the country's extended
international isolation, to profit from lessons learned elsewhere and to identify areas that would
benefit from regional cooperation.




                                                 - 36 -
Statistical Appendix




        - 37 -
INTRODUCTION

This appendix has been prepared according to the Technical Guidelines for the Statistical
Appendix, produced by UNICEF New York in the 2000.

As recommended the statistical appendix reports on progress and achievements using end-
decade indicators. These inform the body of this report and complete the picture on the
situation of children and women in the past decade in the Federal Republic of Yugoslavia.

Two main sources of data were used: official statistics and Multiple Indicator Cluster
Surveys (MICS).

In general, official statistics are reliable and use international standards (unless otherwise
indicated). However, there are a few constraints to keep in mind. The denominator used in
the calculation of many indicators is based on the 1991 Census, and since then there have
been substantial population movements. Also, Albanians from Kosovo and Metohija
boycotted the Census, so their number in the population was estimated. Routine health and
education statistics are well developed but face similar problems. Since the early ‟90s,
Kosovo and Metohija Albanians have boycotted the official health and educational systems
and have tried to develop parallel ones. As a result, vital statistics registration has not been
complete, and it has been difficult to generate reliable health indicators from routine health
information systems. The generation of reliable educational data and indicators has not been
possible. Finally, due to the Kosovo & Metohija crisis, there are no official statistics from
this province for the year 1999. Where official statistics on Kosovo and Metohija for 1998
were the same as for 1997, the 1998 statistics have been disregarded. In these cases the last
complete data for the FRY are for 1997 and the three remaining years are presented with the
data for the FRY excluding Kosovo & Metohija.

The other sources of information were mid-decade and end-decade MICS. The mid-decade
MICS was conducted in October 1996 on the whole territory of FRY, in order to assess
progress towards the World Summit for Children Goals. The survey covered 10,604
households, 2,437 mothers of children aged under five and 3,228 children aged under five.
It was conducted with the Republican Ministries of Health and the Institutes of Public
Health of Serbia and Montenegro. The results helped in proper programme design and in
developing and adjusting the plan of action for children. MICS II (end-decade MICS) was
conducted in July-August 2000. The survey was performed in a particularly difficult
situation, during the sanctions and at the height of a political and economic crisis in the
country. Nevertheless the experience gained through the first MICS helped UNICEF and the
Institutes of Public Health of Serbia and Montenegro to complete the exercise. The survey
was conducted on the territory of FRY, excluding Kosovo & Metohija and it covered a total
of 5,822 households, 4,630 women and 1,674 children under five years of age. The results
have helped to assess progress over the decade, and will be of future programmatic use. Of
particular importance were some of the modules, e.g. breastfeeding and nutritional
anthropometry, which for the first time provided information on these subjects.

To estimate the standard errors for MICS indicators we used the estimation of variance for
the proportion given in the formula below:




                                             - 38 -
       Vp‟= Def*p (1-p)/(n-1),

       where:
                p – proportion for the variance estimate,
                n – sample size, and
                Def – effect of sample planing for the observed group of indicators.

The standard error is the square root of Var xd'.

To calculate the variance for the whole population, the estimations of variance for the
separate domains were summed.

The approximate design effect was derived from the estimation of the variance, of the
simple random sample and from the estimation of variance proposed in the ultimate cluster
method37. The design effect was calculated for all groups of variance and separately for all
observed domains.

The territorial distribution of data includes two states that constitute the federation: the
Republic of Montenegro and the Republic of Serbia, with its administrative parts: Central
Serbia, Vojvodina and Kosovo & Metohija.

The most current situation on progress toward the WSC goals for children of Kosovo &
Metohija is part of a separate report prepared by UNICEF Pristina office, and will be joined
to this report at UNICEF Headquarters.

Not all goals (e.g. guinea worm disease) were relevant to the FRY. Such cases are marked
as not applicable. In the data tables, NA signifies “not available”.




37
  Hansen, M., Hurwitz, W. and Madow, W., Sample Survey Methods and Theory, Volume I, Methods and
Applications, John Wiley and Sons, New York, 1953, p. 257-258.

                                             - 39 -
Goal 1: Between 1990 and the year 2000, reduction of infant and under-five mortality rate by one-third
or to 50 and 70 per 1000 live births respectively, whichever is less

Infant mortality rate         Probability of dying between birth and exactly one year of age, per 1000 live
                              births

Under-five mortality rate     Probability of dying between birth and exactly five years of age, per 1000 live
                              births

Sources of data:              Vital registration


Infant mortality rate

The infant mortality rate is calculated according to international standards. It has been published routinely
since 1948 in various statistical yearbooks. The data are collected from the municipality level and sent
routinely to the regional, republican and federal level. The data are of good quality. They are based on a
standard methodology for data collection, and recording and reporting are obliged by Law. The status of the
data from Kosovo & Metohija is exceptional due to the boycott of the Albanian population. Vital events are
estimated to be under-registered there. This indicator is routinely published in the Statistical Yearbook,
produced by the Federal Statistical Office in Belgrade.

Table 1: Infant mortality rate in Federal Republic of Yugoslavia

Territory                    1990 1991      1992    1993     1994      1995     1996     1997     1998      1999
FR Yugoslavia Total          22.8 20.9       21.7   21.8     18.4      16.8     15.0     14.3     11.8*    11.2*
                Male         23.8 22.8       23.5   23.0     20.3      18.1     16.4     16.2     13.0*    12.5*
                Female       21.7 18.9       19.6   20.6     16.3      15.5     13.5     12.2     10.5*    9.9*
Republic of     Total        16.6 11.2       13.2   15.0     15.4      12.1     13.8     14.8     13.9     13.4
Montenegro      Male         16.5 12.6       15.0   13.6     14.7      11.7     14.7     17.2     15.4     14.5
                Female       16.8 9.81       11.2   16.6     16.2      12.5     13.2     12.2     12.3     12.2
Republic of     Total        23.2 21.6       22.3   22.3     18.6      17.2     15.0     14.3      NA     11.0**
Serbia          Male         24.3 23.5       24.2   23.7     20.7      18.5     16.6     16.2      NA      12.2**
                Female       22.0 19.5       20.3   20.8     16.3      15.7     13.5     12.2      NA      9.6**
Central         Total        17.2 15.4       16.9   17.3     15.7      15.0     15.3     12.1     12.2     11.2
Serbia          Male         19.1 17.2       18.2   19.8     17.1      16.1     17.0     14.3     13.4     12.6
                Female       15.1 13.5       15.5   14.7     14.2      13.7     13.4      9.9     10.9     9.8
Vojvodina       Total        14.1 12.3       13.8   15.2     14.4      10.6     12.8     12.0      9.7     10.2
                Male         15.7 14.2       16.2   15.2     17.4      10.8     14.4     12.5     10.7     11.1
                Female       12.3 10.4       11.3   15.1     11.3      10.3     11.1     11.4      8.6     9.1
Kosovo and      Total        34.4 33.6       34.4   33.3     24.9      23.6     15.9     18.2      NA      NA
Metohija        Male         34.0 35.4       36.6   33.7     27.4      25.6     16.9     20.4      NA      NA
                Female       34.8 31.7       31.9   33.0     22.0      21.4     14.9     15.8      NA      NA
* Data for FRY excluding Kosovo and Metohija
** Data for Republic of Serbia excluding Kosovo and Metohija




                                                   - 40 -
The infant mortality rate presented by linear regression model is shown in figure 1.


                                Figure 1: Infant mortality rate in FRY

                25
                                                                  y = -1.2773x + 24.721
                20


                15                         Rate
                                           Linear (Rate)
                10
                     90

                           91

                                 92

                                       93

                                              94

                                                    95

                                                           96

                                                                   97

                                                                         98

                                                                               99

                                                                                     00
                 19

                          19

                                19

                                      19

                                             19

                                                   19

                                                         19

                                                                  19

                                                                        19

                                                                              19

                                                                                    20
Under-five mortality rate

The under-five mortality rate is an indicator not routinely published in the FRY. It was calculated on the basis
of vital statistics (Table 2).

Table 2: Under five mortality rate in Federal Republic of Yugoslavia

Territory                    1990 1991      1992    1993     1994             1995       1996   1997   1998     1999
FR              Total        26.2 24 .1      24.6   24.9     21.5             19.4       17.6   16.4   13.6*   12.9*
Yugoslavia      Male         27.2 26.3       26.7   26.3     23.6             20.8       19.1   18.7   14.7*   14.1*
                Female       25.1 21.6       22.3   23.4     19.2             17.8       16.0   14.0   12.4*   11.6*
Republic of     Total        18.3 13.0       15.7   16.8     16.5             13.8       15.5   16.9   15.6    14.5
Montenegro      Male         17.9 14.4       18.2   15.3     16.2             13.8       16.6   19.2   16.5    15.1
                Female       18.8 11.5       13.0   18.5     16.9             13.8       14.3   14.3   14.7    13.8
Republic of     Total        26.7 24.8       25.2   25.5     21.8             19.8       17.7   16.4    NA     12.7**
Serbia          Male         27.9 27.1       27.4   27.0     24.1             21.3       19.2   18.6    NA     13.9**
                Female       25.5 22.3       22.9   23.8     19.2             18.1       16.1   14.0    NA     11.3**
Central Serbia Total         19.1 17.6       19.1   19.4     17.7             16.7       16.8   13.6   14.1    12.8
                Male         20.7 19.8       20.8   21.9     19.3             18.1       18.6   15.9   15.3    14.0
                Female       17.3 15.3       17.3   16.7     16.0             15.2       15.0   11.1   12.7    11.5
Vojvodina       Total        16.2 14.3       15.6   17.9     16.7             12.7       15.4   13.5   11.3    12.3
                Male         18.4 16.8       17.9   18.2     19.6             13.4       17.5   14.5   11.9    13.7
                Female       13.8 11.6       13.1   17.7     13.5             11.9       13.8   12.5   10.5    10.7
Kosovo and      Total        40.6 38.7       38.9   38.3     30.4             27.7       20.0   21.7    NA     NA
Metohija        Male         40.2 40.8       41.4   38.8     33.1             29.8       20.9   24.3    NA     NA
                Female       40.9 36.4       36.3   37.6     27.4             25.4       19.0   18.8    NA     NA
* Data for FRY excluding Kosovo and Metohija
** Data for Republic of Serbia excluding Kosovo and Metohija




                                                         - 41 -
The under five mortality rate presented by linear regression model is shown at figure 2.

                            Figure 2: Under five mortality rate in FRY

                 30
                                                           y = -1.4288x + 28.265
                 25


                 20
                                      Rate
                 15                   Linear (Rate)

                 10
                      1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000




                                                     - 42 -
 Goal 2: Between 1990 and the year 2000, reduction of maternal mortality ratio by half


 Maternal mortality ratio       Annual number of deaths of women from pregnancy related causes, when
                                pregnant or within 42 days of termination of pregnancy, per 100,000 live births

 Sources of data:               Vital registration


 Although not published in routine statistical yearbooks, this indicator was easily calculated from statistics of
 mortality by cause of deaths (ICD, 10th revision, causes POO - P99).
 The data are of good quality, except for Kosovo and Metohija.

 The maternal mortality ratio in the FRY over the decade is shown in Table 3.

 Table 3: Maternal mortality ratio (per 100 000 live births) in FR Yugoslavia

Territory                  1990     1991   1992    1993    1994         1995     1996    1997       1998   1999
FR Yugoslavia              11.0     13.1     8.5    17.7    13.1        12.1      7.3   20.3*     14.0*     8.6*
Republic of Montenegro     21.3     31.2    10.5    11.2    45.0          -        -    11.4      32.6        -
Republic of Serbia         10.3     11.9     8.4    18.8    10.9        13.0      7.8    13.9**    11.8** 9.7**
Central Serbia             14.8     19.3    10.8    15.8    12.6        15.7      8.2   25.4      10.6    11.2
Vojvodina                    -       4.4     4.5    18.8    23.1         4.4      9.2   9.7       15.1    5.3
Kosovo and Metohija         9.1      5.7     6.7    22.7     2.3        13.4      6.5   NA        NA        NA
 * Data for FRY excluding Kosovo and Metohija
 ** Data for Republic of Serbia excluding Kosovo and Metohija




                                                      - 43 -
Goal 3: Between 1990 and the year 2000, reduction of severe and moderate malnutrition among under-
five children by half

Underweight prevalence          Proportion of under-fives who fall below minus 2 and below minus 3 standard
                                deviations from median weight for age of NCHS/WHO reference population

Stunting prevalence             Proportion of under-fives who fall below minus 2 and below minus 3 standard
                                deviations from median height for age of NCHS/WHO reference population

Wasting prevalence              Proportion of under-fives who fall below minus 2 and below minus 3 standard
                                deviations from median weight for height of NCHS/WHO reference population

Sources of data:                Household surveys     (MICS 1996 and MICS 2000)

Anthropometric indicators were calculated in the Multiple Indicator Cluster Surveys, performed in 1996 and
2000. In the MICS I (1996) the response rate was 95.7. In the MICS II (2000), the response rate was 97.7
percent (2.3 percent missing height or weigh), while 5.8% of values were rejected as outliners. In both surveys
standard UNICEF equipment was used (UNICSAL and height measuring instruments). Measurement was
performed by trained health workers. In order to measure trends, confidence intervals were also calculated.
The results for MICS II are presented on Tables 4 and 5.

      Table 4: Percentage of under-five children, who are severely or moderately undernourished

Territory               Weight        Weight      Height for   Height for    Weight for    Weight for     Number
                      for age: -2   for age: -3    age: -2      age: -3      height: -2    height: -3        of
                          SD            SD           SD           SD            SD            SD          children
FRY excl. K & M           1.9            .4          5.1          1.9            3.7            .7        1519
R. of Montenegro          2.1            .8          9.0          4.2            4.6            .3         134
R. of Serbia excl.        1.9            .3          4.7          1.6            3.7            .7        1386
K&M
 Central Serbia           2.0            .4          5.3           2.0            4.3            .8       1030
 Vojvodina                1.6            .0          3.0            .5            1.9            .3        356
Area
Urban                     1.1            .2          4.2           1.2            3.6            .7        893
Rural                     3.1            .6          6.3           2.7            3.9            .6        626
Gender
Male                      1.9            .4          5.4           1.8            3.3            .4        788
Female                    2.0            .3          4.7           1.9            4.2            .9        731
Age
< 6 months                 .7            .0          2.2           1.3            4.6            .0        139
6-11 months               1.2           1.2          6.4           2.1            5.9           1.5        155
12-23 months              2.8           1.0          6.5           2.7            3.8            .1        304
24-35 months              1.1            .0          2.5            .6            2.1            .2        295
36-47 months              1.0            .0          6.5           2.6            3.3            .5        304
48-59 months              3.6            .3          5.4           1.7            4.2           1.6        323
Mother’s
education
None/primary              4.8           1.3          7.4           3.4            5.2            .8        341
Secondary                 1.3            .1          4.4           1.4            3.5            .6        912
Higher/high                .3            .2          4.2           1.6            2.6            .5        266




                                                    - 44 -
     Table 5: Percentage of under-five children, who are severely or moderately overweight/height

Territory             Weight       Weight    Height for   Height for   Weight for   Weight for      Number
                     for age:     for age:    age: +2      age: +3     height: +2   height: +3         of
                      +2 SD        +3 SD        SD           SD           SD           SD           children
FRY excl. K & M       15.5          5.8        17.7         7.4          14.3          6.1            1519
R. of Montenegro      17.4          7.9        20.9       11.3           21.5       10.3               134
R. of Serbia excl.    15.3          5.6        17.4         7.1          13.6          5.7            1386
K&M
 Central Serbia       14.7          6.1         19.1         8.0         13.9          5.5           1030
 Vojvodina            17.0          4.3         12.4         4.5         12.7          6.4            356
Area
Urban                 15.5          5.6         17.5         7.6         14.0          5.7             893
Rural                 15.4          6.2         17.9         7.3         14.7          6.7             626
Gender
Male                  14.4          5.0         17.0         7.6         12.9          4.7             788
Female                16.6          6.8         18.4         7.2         15.8          7.7             731
Age
< 6 months             8.3          0.0         12.3         3.0          7.3          0.7             139
6-11 months           11.2          1.5         14.9         6.4         13.8          8.0             155
12-23 months          18.2          8.1         15.6         9.0         18.5          9.3             304
24-35 months          16.2          6.9         20.9         8.2         15.3          5.0             295
36-47 months          17.7          6.1         18.6         6.8         14.7          5.7             304
48-59 months          15.2          7.1         19.5         8.3         12.2          6.0             323
Mother’s
education
None/primary          11.2          4.9         14.0         5.2         11.4          4.2             341
Secondary             16.6          6.8         18.3         8.3         15.4          7.4             912
Higher/high           17.2          3.6         20.3         7.3         14.1          4.1             266




                                                - 45 -
In order to analyse trend between mid and end-decade, data from MICS I were recalculated (Kosovo &
Metohija is excluded from the sample). Confidence intervals were calculated. The results are presented in
figure 3.



                                                                              Figure 3: Prevalence of malnutrition in children under five

                                                        8.00

                                                               By each measure (underweight, wasting and stunting), the increase 1996-2000 in prevalence
                                                               is statistically significant.
                                                        7.00


                                                                                                                                                                  6.40
   % of children with moderate or severe malnutrition




                                                        6.00




                                                        5.00
                                                                                                                                                                  5.10
                                                                                                                             4.81


                                                        4.00
                                                                                                                             3.70                                 3.80


                                                        3.00
                                                                                                                                                2.85
                                                                                           2.70                              2.59
                                                                                                            2.37
                                                        2.00                                                                                    2.10
                                                                                           1.90
                                                                                                            1.70
                                                                                                                                                1.35
                                                                                           1.10            1.03
                                                        1.00
                                                                       0.87
                                                                       0.50
                                                                       0.13
                                                        0.00
                                                               Underweight-1996   Underweight-2000   Wasting-1996     Wasting-2000       Stunting-1996     Stunting-2000




                                                                                                        - 46 -
Goal 4: Universal access to safe drinking water

Use of improved drinking            Proportion of population who use any of the following types of water supply for
water sources                       drinking: (1) piped water to household; (2) public standpipe/tap; (3)
                                    borehole/pump; (4) protected well; (5) protected spring; (6) rainwater

Sources of data:                   Census 1991, household surveys: MICS 1996 and MICS 2000

Three sources of information were used to calculate this indicator. Multiple definitions of improved drinking
water sources were recently introduced and calculated in the MICS 2000. However, given the country‟s level
of water supply infrastructure, a better understanding of access can be had by calculating the percentage of
population using drinking water piped into the dwelling or piped into the yard or plot. For that purpose data
from the Census 1991, MICS 1996 and MICS 2000 were used. In order to analyse trends, confidence intervals
for the FRY as a whole and FRY excluding Kosovo and Metohija were calculated for the MICS.

Table 6 provides recent data from MICS 2000, covering FR Yugoslavia excluding Kosovo and Metohija:

Table 6: Percentage of the population using improved drinking water sources

Territory                                     Main source of water                           Total Total with Number
                 Piped into Piped into Public Tubewell/ Protected Unprotected Other Missing/       improved     of
                  dwelling yard or      tap Borehole dug well dug well               DK             drinking persons
                               plot           with pump                                              water
FRY excl. K
                   83.8      2.8      0.6      4.4      6.8        0.7         0.5   0.3       100      98.4    18791
&M
Republic of
                   85.1      6.0      1.0      1.1      3.0        0.4         2.2   1.2       100      96.1     1227
Montenegro
R Serbia excl.
                   83.7      2.6      0.6      4.6      7.0        0.8         0.4   0.3       100      98.6    17564
K&M
Central Serbia     81.3      2.6      0.6      4.4      9.6        1.0         0.3   0.2       100      98.5    12892
Vojvodina          90.4      2.5      0.7      5.2      0.1        0.0         0.7   0.5       100      98.8     4671
Area
Urban              97.5      1.0      0.1      0.4      0.4        0.0         0.3   0.3       100      99.4    10077
Rural              68.0      4.8      1.3      9.1      14.1       1.6         0.8   0.3       100      97.2     8714

Important aspect of water access - interruptions in water supply are shown in table 7:

Table 7: Interruptions in water supply, by households, MICS 2000

Territory                                     No          Yes,       Yes, on daily         Yes, during the     Number
                                                        sporadic         basis             summer season
FR Yugoslavia excl K & M                     51.7         28.4            5.0                    15.0          5730
Republic of Montenegro                       41.5         29.9            7.1                    21.4           350
Republic of Serbia excl. K & M               52.3         28.3            4.9                    14.6          5380
Central Serbia                               57.4         23.5            5.8                    13.4          3849
Vojvodina                                    39.6         40.3            2.6                    17.6          1531
Area
Urban                                        55.9         26.8           3.7                    13.6           3270
Rural                                        46.0         30.4           6.7                    16.8           2460

Measurement of country progress towards the universal access to safe drinking water is possible by using the
more restricted criterion of the percentage of the population that uses water piped into the dwelling or into the
yard. This information is presented in Table 8.




                                                       - 47 -
Table 8: Percentage of the population using drinking water piped into dwelling or yard,
by territory

 Territory                              1991 Census            MICS 1996              MICS 2000
 FR Yugoslavia                              78.7                 76.7*                 86.6**
 Republic of Montenegro                     76.3                 85.9                  91.1
 Republic of Serbia                         NA                   76.0                  86.3***
 Central Serbia                             81.0                 78.6                  83.9
 Vojvodina                                  90.9                 92.0                  92.9
 Kosovo and Metohija                      35.1****               51.6                  NA

* 95 percent confidence limits are 75.6 – 77.8
** Data for FRY excluding Kosovo and Metohija
*** Data for Republic of Serbia excluding Kosovo and Metohija
****Estimated value

In order to compare data over time, and to analyse urban/rural disparities, data for the FRY excluding Kosovo
were recalculated (Table 9).

Table 9: Percentage of the population using drinking water piped into dwelling or yard,
FRY excluding Kosovo and Metohija

 Territory                              1991 Census            MICS 1996              MICS 2000
 FR Yugoslavia excluding                   83.2                  82.4*                 86.6**
 Kosovo and Metohija
 Area
 Urban                                      NA                    98.6                  98.5
 Rural                                      NA                    64.8***               72.8****

* 95 percent confidence limits are 81.4 – 83.4
** 95 percent confidence limits are 85.4 – 87.8
*** 95 percent confidence limits are 63.5 – 66.1
**** 95 percent confidence limits are 71.2 – 74.4




                                                    - 48 -
 Goal 5: Universal access to sanitary means of excreta disposal


 Use of improved sanitary               Proportion of population who use any of the following types of sanitation
 means of excreta disposal              facilities:(1) toilet connected to sewage system; (2) toilet connected to septic
                                        system (3) pour-flush latrine; (4) improved pit latrine; (5) traditional pit latrine

 Sources of data:                   Census 1991, household surveys: MICS 1996 and MICS 2000


 As with the previous goal, there are several sources of information for calculating this indicator. Multiple
 definitions of sanitary means of excreta disposal were introduced in the MICS 2000. However, a more
 restricted and country-appropriate definition of sanitary means of excreta disposal is the percentage of the
 population using toilets with flush to sewage system or flush to septic tank. For that purpose data from the
 Census 1991, MICS 1996 and MICS 2000 were used. In order to analyse trends, confidence intervals for the
 FRY as a whole and FRY excluding Kosovo and Metohija were calculated.

 The MICS 2000 results for the FRY excluding Kosovo and Metohija are shown in Table 10.

 Table 10: Percentage of the population using sanitary means of excreta disposal

Territory                                 Type of toilet facility                              Total   Total with Number
                   Flush to    Flush to Improved pit Traditional          No        Missing/            sanitary of persons
                   sewage     septic tank  latrine      pit latrine    facilities     DK               means of
                   system                                                                               excreta
                                                                                                        disposal
FRY excl.
                    57.2         31.1            0.7         10.5         0.1         0.3      100       99.6      18791
K&M
Republic of
                    60.6         28.2            0.6          8.4         0.7         1.5      100       97.8       1227
Montenegro
R Serbia excl. K
                    57.0         31.3            0.7         10.7         0.1         0.3      100       99.7      17564
&M
Central Serbia      61.7         25.6            0.8         11.6         0.1         0.2      100       99.8      12892
Vojvodina           44.1         47.2            0.3         7.9          0.0         0.5      100       99.5       4671
Area
Urban               87.5         10.1            0.1         1.9          0.0         0.4      100       99.6      10077
Rural               22.2         55.5            1.3         20.4         0.2         0.3      100       99.5       8714


 The progress in the percentage of population using toilets flush to sewage system or flush in septic tanks is
 shown in Table 11.

 Table 11: Percentage of the population using a toilet facility linked to a sewage system or septic tank in
 the dwelling, by territory

  Territory                                    1991 Census              MICS 1996                MICS 2000
  FR Yugoslavia                                   62.6                    73.4*                    88.3**
  Republic of Montenegro                          66.1                    84.0                     88.8
  Republic of Serbia                                                      72.8                     88.3***
  Central Serbia                                    64.1                  74.4                     87.3
  Vojvodina                                         70.2                  82.5                     91.3
  Kosovo and Metohija                             32.0****                57.6                     …

 * 95 percent confidence limits are 72.2 – 74.6
 ** Data for FRY excluding Kosovo and Metohija
 *** Data for Republic of Serbia excluding Kosovo and Metohija
 ****Estimated value




                                                             - 49 -
For trend analysis, data were recalculated for FRY excluding Kosovo and Metohija. The data are shown on
table 12.

Table 12: Percentage of the population using a toilet facility linked to a sewage system or septic tank in
the dwelling, FRY excluding Kosovo and Metohija

 Territory                             1991 Census             MICS 1996             MICS 2000
 FR Yugoslavia excluding                  65.8                   77.0*                88.3**
 Kosovo & Metohija
 Area
 Urban                                      NA                   94.2***              97.6****
 Rural                                      NA                   58.6*****            77.7******

* 95 percent confidence limits are 76.0 – 78.0
** 95 percent confidence limits are 87.1 – 89.5
*** 95 percent confidence limits are 93.6 – 94.8
**** 95 percent confidence limits are 97.1 – 98.1
***** 95 percent confidence limits are 57.4 – 59.8
****** 95 percent confidence limits are 76.3 – 79.1


Percentage of households by method of garbage disposal are presented at table 13:

Table 13: Households by method of garbage disposal and type of settlement, MICS 2000

Territory      Taken away Disposed of Left at an Burned Buried         Dumped       Thrown at Other Number
                by public at a public illegal dump                     near the      the river
                 utility     dump                                       house
FRY excl.
                  54.7        25.3         6.4           6.3   0.3         5.4        1.1        0.5   5730
K&M
Republic of
                  41.7        38.1         6.2           4.9   0.1         0.9        5.9        2.2   350
Montenegro
Republic of
Serbia excl.      55.6        24.4         6.4           6.4   0.3         5.7        0.8        0.4   5380
K&M
Central
                  49.7        25.4         8.2           8.2   0.3         6.8        1.1        0.3   3849
Serbia
Vojvodina         70.4        22.1         1.9           1.9   0.2         3.0        0.1        0.4   1531
Area
Urban             79.6        18.3          0.5          0.3   0.0         0.9        0.1        0.3   3270
Rural             21.9        34.4         14.2         14.3   0.6        11.3        2.5        0.7   2460




                                                      - 50 -
Goal 6: Universal access to basic education and achievement of primary education by at least 80 per
cent of primary school-age children through formal schooling or non-formal education of comparable
learning standard, with emphasis on reducing the current disparities between boys and girls

Children reaching grade 5      Proportion of children entering first grade of primary school who eventually
                               reach grade 5

Net primary school             Proportion of children of primary school age enrolled in primary
enrolment ratio                school

Net primary school             Proportion of children of primary school age attending primary
attendance rate                school

Sources of data:               Administrative data and MICS 2000

The children reaching grade five indicator was calculated from MICS 2000 and from administrative data,
published by Federal Statistical Office, Belgrade. There are some difficulties with the administrative data as a
result of population movements. Further, due to the boycott of the Albanian population (as of 1991) of the
official educational system, administrative data from this province are not complete .

Net primary school attendance rate was calculated from MICS 2000 data.

The percentage of children reaching grade five are presented in Table 14.

Table 14: Percentage of children entering first grade of primary school who eventually reach grade 5,
MICS 2000

Territory                              Percent in      Percent in     Percent in     Percent in     Percent who
                                        grade 1         grade 2        grade 3        grade 4      reach grade 5
                                       reaching        reaching       reaching       reaching       of those who
                                        grade 2         grade 3        grade 4        grade 5      enter grade 1
FRY excl. K & M                          97.2            99.6           98.9           97.9             93.8
Republic of Montenegro                   97.2            99.0           100            97.5             93.8
Republic of Serbia excl. K & M           97.3            99.6           98.8           97.9             93.8
Central Serbia                           96.6            100            99.1           98.4             94.2
Vojvodina                                100             98.6           98.0           96.8             93.5
Gender
Male                                      98.2           100             98.8           96.4           93.6
Female                                    96.5           99.0            99.0           99.1           93.7
Area
Urban                                     96.9           100             98.7           99.7           95.4
Rural                                     97.6           99.1            99.1           96.0           92.0




                                                     - 51 -
 Gross primary school enrolment rate is shown at Table 15.

 Table 15: Gross primary school enrolment rate (%)

Territory                1990 1991      1992       1993      1994    1995    1996    1997    1998    1999
FR             Total     94.4   72.4     73.9       72.5      71.6    72.7    71.8    70.7   98.9*   97.5*
Yugoslavia     Male      95.1   72.3     74.4       72.9      71.8    73.1    72.0    70.9   99.8*   98.3*
               Female    93.6   72.3     73.4       72.1      71.3    72.3    71.0    70.4   98.0*   96.7*
Republic of    Total     96.0   96.7     99.3       98.0      96.8    97.0    95.8    95.3    95.5    95.7
Montenegro     Male      96.7   97.3    100.1       98.5      97.1    97.3    96.6    95.6    96.0    96.2
               Female    95.2   96.3     98.4       97.5      96.4    96.8    94.5    95.0    95.0    95.2
Republic of    Total     94.3   70.6     72.1       70.7      69.8    71.0    70.1    69.0    NA      NA
Serbia         Male      95.0   70.5     72.5       71.0      70.0    71.4    70.4    69.2    NA      NA
               Female    93.5   70.6     71.7       70.3      69.5    70.6    69.8    68.7    NA      NA
Central        Total     94.9   95.1     97.7       96.8      96.2    97.6    97.6    96.6    95.9    94.9
Serbia         Male      94.9   95.4     97.8       96.8      96.4    97.9    97.6    96.5    96.1    95.2
               Female    94.9   95.0     97.5       96.7      96.0    97.3    97.5    96.7    95.8    94.7
Vojvodina      Total     95.6   99.0    105.7      104.0     104.1   110.6   109.6   109.6   109.2   106.1
               Male      95.5   99.0    109.3      107.7     106.9   113.9   112.6   113.4   112.9   109.1
               Female    95.8   99.0    102.1      100.3     101.5   107.3   106.3   105.9   105.6   103.1
Kosovo &       Total     92.4   11.6     11.3       10.9      10.8    10.9    10.7    10.5    NA      NA
Metohija       Male      94.8   11.6     11.5       11.0      11.0    11.0    10.9    10.7    NA      NA
               Female    89.7   11.1     11.1       10.8      10.6    10.7    10.5    10.3    NA      NA
 * Data for FRY excluding Kosovo and Metohija




                                                    - 52 -
The net primary school attendance rate, calculated from MICS 2000 data is presented in following table:

Table 16: Percentage of children of primary school age attending primary school

Territory                                            Sex                                         Total
                                     Male                          Female
                         Attending          Number         Attending     Number         Attending         Number
FRY excl K & M                98.2            748             96.6         759            97.4             1508
Republic of                   96.9             69             97.6          68            97.2              137
Montenegro
Republic of Serbia            98.3           679              96.5          692           97.4            1371
excl. K & M
 Central Serbia               98.1           488              97.4          485           97.8             973
 Vojvodina                    98.7           191              94.4          207           96.5             398
Area
Urban                         98.0           401              98.4          408           98.2             809
Rural                         98.4           347              94.6          352           96.5             699
Age
 8                            99.5           111              93.1           99           96.5             210
 9                            98.4           113              94.7          109           96.6             223
 10                           96.3            92              97.2          104           96.8             196
 11                           97.6            94              98.2          106           97.9             200
 12                           99.6            88              97.9           91           98.7             180
 13                          100.0           110              97.4           92           98.8             202
 14                           97.0            85              97.8          115           97.5             200
 15                           95.0            55              96.8           43           95.8              98




                                                     - 53 -
Goal 7: Reduction of the adult illiteracy rate (the appropriate age group to be determined in each
country) to at least half its 1990 level, with emphasis on female literacy

Literacy rate                   Proportion of the population aged 15 years and older who are able, with
                                understanding, to both read and write a short simple statement on their
                                everyday life


Sources of data:                Census 1991


The only source for calculating the literacy rate is the Census 1991.

The data are presented in table 17.

Table 17: Literacy rate (population aged 15+)

Territory                         Total       Male     Female
FR Yugoslavia                     92.4        97.0      87.9
Republic of Montenegro            93.0        97.8      89.4
Republic of Serbia                92.3        96.9      87.8
Central Serbia                    92.7        97.6      88.0
Vojvodina                         95.6        98.0      93.3
Kosovo and Metohija               86.4        93.3      79.1




                                                     - 54 -
Goal 8: Provide improved protection of children in especially difficult circumstances and tackle the root
causes leading to such situations

Total child disability rate   Proportion of children aged less than 15 years with some reported physical or
                              mental disability


There are no available data to calculate this indicator in FR Yugoslavia.




                                                  - 55 -
Goal 9: Special attention to the health and nutrition of the female child and to pregnant and lactating
women

Under-five mortality          Probability of dying between birth and exactly five years of age, per 1000
rate– female/male             live births disaggregated by gender

Underweight prevalence-       Proportion of under-fives who fall below minus 2 standard deviations from
female/male                   median weight for age of NCHS/WHO reference population – disaggregated
                              by gender

Antenatal care                Proportion of women aged 15-49 attended at least once during pregnancy by
                              skilled health personnel

HIV prevalence                Proportion of population aged 15-49 who are HIV positive – disaggregated by
                              gender and age

Anaemia                       Proportion of women aged 15-49 years with haemoglobin levels below 12
                              grams/100 ml blood for non-pregnant women, and below 11 grams/100 ml
                              blood for pregnant women


There are no data on Antenatal care and HIV prevalence among the general population. The data on
other indicators are explained elsewhere in the statistical report: under five mortality rate in chapter 1;
underweight in chapter 3; anaemia in chapter 13.




                                                   - 56 -
Goal 10: Access by all couples to information and services to prevent pregnancies that are too early, too
closely spaced, too late or too many

Contraceptive prevalence           Proportion of women aged 15-49 who are using (or whose partner is using) a
                                   contraceptive method (either modern or traditional)

Fertility rate for women           Number of live births to women aged 15-19 per 1000 women aged 15-19
15 to 19

Total fertility rate               Average number of live births per woman who has reached the end of her
                                   childbearing period


Sources of data:                   Household survey MICS 2000, vital registration system


The contraceptive prevalence was calculated from MICS 2000 data. The contraceptive module included a total
of 3076 of currently married women aged 15–49 years of age. The two other indicators were calculated from
data of the vital registration system.


Table 18: Percentage of married or in union women aged 15-49 who are using (or whose partner is
using) a contraceptive method*

Territory                                 Current method                         Total Any      Any       Any Number
                No    Pill   IUD Vaginal Condom Diaphrag Periodic Withdraw Other      modern traditional method    of
               method            methods             m       abstinenc al             method method             currently
                                                  foam/jelly     e                                               married
                                                                                                                 women
FRY excl.
               41.0    4.7   7.8    1.2    17.5      1.8     14.3      11.3    0.6   100   32.9    25.6   58.4     3076
K&M
R. of
               47.1    6.8   7.6    0.7    13.6      2.0     10.6      11.4    0.2   100   30.7    22.0   52.7      212
Montenegro
R. of Serbia
               40.6    4.5   7.8    1.2    17.7      2.0     15.0      11.3    0.6   100   33.0    25.8   58.7     2869
excl. K & M
Central
               41.5    4.1   7.1    1.2    17.2      2.0     14.6      11.7    0.5   100   31.6    26.3   57.9     2132
Serbia
Vojvodina      38.1    5.6   9.6    1.4    19.1      1.2     14.1      10.1    0.9   100   36.9    24.2   61.1      737
Area
Urban          36.0    5.8   8.1    1.5    20.6      2.4     15.0      10.3    0.4   100   38.2    25.3   63.6     1610
Rural          46.5    3.5   7.4     .9    14.0      1.2     13.4      12.4    0.8   100   27.0    25.8   52.8     1465
Age
15-19          59.1    0.0   0.0    8.7    22.6      0.0      4.4       5.1    0.0   100   31.3     9.5   40.9       25
20-24          45.4    1.5   3.8    0.5    20.9      0.4     13.5      13.7    0.4   100   27.0    27.1   54.2      271
25-49          40.4    5.0   8.2    1.2    17.1      2.0     14.4      11.1    0.6   100   33.5    25.5   59.0     2780
Mother’s
education
None/
               56.2    3.9   6.0    1.2     9.6      0.9         9.4   12.7    0.3   100   21.5    22.0   43.5      844
Primary
Secondary      37.8    4.5   8.2    0.8    19.0      1.8     16.0      11.4    0.7   100   34.3    27.4   61.7     1677
Higher/high    28.0    6.2   9.1    2.3    24.9      3.2     16.4       9.0    0.8   100   45.9    25.4   71.3      554

* Columns may not end up correctly due to rounding error




                                                        - 57 -
The adolescent fertility rate is shown in Table 19.

Table 19: Adolescent fertility rate

Territory                      1990    1991      1992   1993     1994   1995   1996   1997   1998
FR Yugoslavia                  41.0    39.7      35.3   35.1     33.8   32.0   30.1   28.0   26.3
Republic of Montenegro         25.9    28.5      25.4   24.3     21.8   23.6   22.8   19.9   20.9
Republic of Serbia             42.1    40.5      36.0   35.9     34.6   32.6   30.6   28.5   28.4
Central Serbia                 44.9    43.8      39.8   40.8     38.5   35.8   33.0   31.7   28.5
Vojvodina                      43.1    40.9      37.6   35.9     34.5   33.1   31.3   28.5   28.0
Kosovo & Metohija              36.2    33.8      27.8   27.0     27.9   26.6   25.9   23.0   22.9


The total fertility rate is shown in Table 20.

Table 20: Total fertility rate

Territory                      1990    1991      1992   1993     1994   1995   1996   1997   1998
FR Yugoslavia                  2.08    2.08      1.91   1.91     1.85   1.88   1.83   1.74   1.67
Republic of Montenegro         1.79    2.05      2.01   1.88     1.86   1.95   1.87   1.79   1.87
Republic of Serbia             2.10    2.08      1.91   1.91     1.85   1.87   1.83   1.74   1.48
Central Serbia                 1.75    1.73      1.68   1.70     1.65   1.65   1.58   1.53   1.47
Vojvodina                      1.69    1.72      1.67   1.67     1.66   1.72   1.66   1.58   1.53
Kosovo & Metohija              3.58    3.51      2.82   2.71     2.56   2.54   2.55   2.32   2.27




                                                        - 58 -
Goal 11: Access by all pregnant women to pre-natal care, trained attendants during childbirth and
referral facilities for high-risk pregnancies and obstetric emergencies

Antenatal care                  Proportion of women aged 15-49 attended at least once during pregnancy by
                                skilled health personnel

Childbirth care                 Proportion of births attended by skilled health personnel

Obstetric care                  Number of facilities providing comprehensive essential obstetric care per
                                500,000 population

                                Number of facilities providing basic essential obstetric care per 500,000
                                population


Sources of data:                Vital registration, routine health statistics


There are no data on the proportion of women aged 15-49 who were attended by skilled health personnel
during pregnancy. Data for childbirth and obstetrics care are provided by routine health statistics.

In Table 21, childbirth care is presented.

Table 21: Proportion of birth attended by skilled health personnel

Territory                    1990 1991 1992            1993    1994    1995     1996   1997    1998   1999
FR Yugoslavia                90.6 89.1 90.2            90.4    90.3    91.7     92.6   92.8   99.1*   98.9*
Republic of Montenegro       98.3 98.5 98.0            98.3    98.4    98.8     99.0   99.4   99.1    99.3
Republic of Serbia           90.1 88.5 89.7            89.9    89.7    91.2     92.1   92.4   NA      NA
 Central Serbia              97.8 97.6 97.7             98     97.8    98.4     98.5   98.9   98.9    98.6
 Vojvodina                   99.7 99.7 99.7            99.7    99.7    99.6     99.8   99.7   99.8    99.7
 Kosovo and Metohija         76.7 71.9 73.0            72.8    72.9    76.8     80.1   79.8   NA      NA
* Data for FRY excluding Kosovo and Metohija




                                                     - 59 -
Goal 12: Reduction of the low birth weight (less than 2.5 kg) rate to less than 10 per cent

Birth weight below 2.5 kg     Proportion of live births that weigh below 2500 grams


Sources of data:              Vital events registration system


Although measurement at birth was introduced more than 40 years ago, registration of data and publishing of
this information in the health statistical yearbook started in 1994. These data are presented in Table 22.

Table 22: Proportion of live births that weigh below 2 500 grams

Territory                   1994    1995        1996        1997    1998    1999
FR Yugoslavia               4.88     4.82       5.30        4.96    4.95*   5.09*
Republic of Montenegro      4.16     4.17       4.07        4.58    4.56    5.10
Republic of Serbia          4.93     5.38       5.38        4.99     NA      NA
Central Serbia              5.06     4.68       5.19        4.93    5.01    5.16
Vojvodina                   5.45     5.10       5.34        5.37     5.14   4.88
Kosovo and Metohija         4.47     5.01       5.67        4.88     NA      NA
* Data for FRY excluding Kosovo and Metohija

Table 22a: Proportion of live births with unknown weight

Territory                   1994    1995        1996        1997    1998    1999
FR Yugoslavia               23.68   20.69       20.27       20.42   19.9*   10.29*
Republic of Montenegro      18.05   17.74       12.72        5.79    4.98    6.47
Republic of Serbia          24.07   20.90        20.8       21.47    NA      NA
Central Serbia              16.95   12.25       11.43       11.15   10.04   10.20
Vojvodina                   10.67   11.70       11.42       12.98   11.93   12.36
Kosovo and Metohija         41.18   37.84       37.61       39.76    NA      NA
* Data for FRY excluding Kosovo and Metohija




                                                   - 60 -
Goal 13: Reduction of iron deficiency anaemia in women by one third of the 1990 levels

Anaemia                        Proportion of women aged 15-49 years with haemoglobin levels below 12-
                               grams/100 ml blood for non-pregnant women, and below 11-grams/100 ml
                               blood for pregnant women


Sources of data:               MICS 2000


In MICS 2000, haemoglobin levels in the blood of women aged 15 – 49 years were measured. The data are of
good quality, the standard equipment (Hemocue) for blood samples were used and samples were taken by
trained health professional, according to the standard procedure. The blood test was done for each third woman
in the sample – 1296 out of the total of 4630 women. The results are presented in the following table:

   Table 23: Percentage of women aged 15-49 with haemoglobin levels below 12-grams/100 ml blood

Territory                      Percentage of women aged        Number of        Total number of
                                15-49 with haemoglobin          women               women
                                levels below 12 g/100 ml
FRY excl. K & M                            26.7                    346               1296
Republic of Montenegro                     20.6                      4                 19
Republic of Serbia                         26.8                    342               1277
excl. K & M
 Central Serbia                           27.3                     262                959
 Vojvodina                                25.4                      81                317
Area
Urban                                     26.6                     161                607
Rural                                     26.8                     185                689
Age
15-19                                     20.7                      30                146
20-24                                     28.8                      51                177
25-29                                     27.6                      57                208
30-34                                     23.6                      49                209
35-39                                     25.1                      43                172
40-44                                     27.3                      49                180
45-49                                     32.5                      66                203
Mother’s education
None/primary                              28.6                     119                418
Secondary                                 24.7                     165                667
Higher/high                               29.4                      62                211




                                                    - 61 -
Goal 14: Virtual elimination of iodine deficiency disorders

Iodised salt consumption      Proportion of households consuming adequately iodised salt

Low urinary iodine            Proportion of population (school age children or general population) with
                              urinary iodine levels below 10 micrograms/100ml urine


Sources of data:              Household survey (MICS 2000) and Study on urinary iodine level among
                              school aged children in Republic of Serbia


The only national available data for iodised salt consumption are from MICS 2000. Out of 5731 households
interviewed 99.2 percent were tested. The standard UNICEF test kits were used. The measurement was
performed by trained health professionals.

In order to determine IDD status in the country, a survey was conducted using a representative sample in
Republic of Serbia in 1999. Following the general guidelines of WHO, UNICEF and ICCIDD, the survey
encompassed school children aged 7 to 15 years. Their thyroid volume was measured by ultrasonography, and
urinary iodine concentrations were determined by ceric-arsenite method. Urinary iodine determinations were
performed in the Biochemical Laboratory of the National Endocrinology Research Centre, Russian Academy
of Medical Sciences, in Moscow.


The proportion of households consuming adequately iodised salt is presented in Table 24.

Table 24: Percentage of households consuming adequately iodised salt

Territory                Percent of     Percent of                 Result of test          Number of
                       households with households in                                       households
                           no salt     which salt was         < 15 PPM       15+ PPM       interviewed
                                           tested
FRY excl K & M               0.3            99.2                26.8            73.2           5731
Republic of
                             0.3              99.3              29.3            70.7             350
Montenegro
Republic of Serbia
                             0.2              99.1              26.7            73.3           5381
excl. K & M
Central Serbia               0.2              99.2              23.0            77.0           3849
Vojvodina                    0.5              98.9              37.2            62.8           1531
Area
Urban                        0.3              99.1              29.0            71.0           3270
Rural                        0.2              99.3              24.2            75.8           2461




                                                     - 62 -
The criteria which determine eradication: the median level of urinary iodine between 100 and 300 mcg/L, with
the proportion of children below 50 mcg/L not to exceed 20%; and the prevalence of goitre in school children
below 5%. The results from the IDD Survey among school children in the Republic of Serbia are shown in
Table 25. The retrieved median urinary iodine concentration was 158 mcg/l of urine.

Table 25. The median (P50) and the upper limit of normal by the thyroid volume (P97)
by age and sex

                          Median                                       P97
 Age         Boys          Girls          Total         Boys          Girls          Total
 7           3.52          3.56           3.55           5.55          6.11           5.74
 8           3.70          3.80           3.73           5.93          7.07           6.36
 9           4.03          4.22           4.11           7.25          7.40           7.29
 10          4.32          4.58           4.43           7.83          8.44           7.82
 11          5.08          5.12           5.11           8.28          9.27           8.70
 12          5.47          5.97           5.66           9.45          9.94           9.89
 13          5.67          6.04           5.85          11.36         12.16          11.38
 14          6.65          6.90           6.76          12.61         14.52          13.40
 15          6.93          7.34           7.10          14.16         15.20          14.63




                                                   - 63 -
Goal 15: Virtual elimination of vitamin A deficiency and its consequences, including blindness


Children receiving           Proportion of children 6-59 months of age who have received a high dose
Vitamin A supplements        vitamin A supplement in the last 6 months

Mothers receiving            Proportion of mothers who received a high dose vitamin A supplement
Vitamin A supplements        before infant was 8 weeks old

Low vitamin A                Proportion of children 6-59 months of age with serum retinol below 20
                             micrograms/100 ml


Vitamin A deficiency is not considered a public health problem in FRY. There were no scientific data on
Vitamin A deficiency, but clinical signs of Vitamin A deficiency are not registered in the country.




                                                 - 64 -
 Goal 16: Empowerment of all women to breast-fed their children exclusively for four to six months and
 to continue breastfeeding, with complementary food, well into the second year

 Exclusive breastfeeding         Proportion of infants less than 4 months (120 days) of age who are
 rate                            exclusively breastfed

 Timely complementary            Proportion of infants 6-9 months (180-299 days) of age who are receiving
 feeding rate                    breastmilk and complementary food

 Continued breastfeeding         Proportion of children 12-15 months and 20-23 months of age who are
                                 breastfeeding

 Number of baby-friendly         Number of hospitals and maternity facilities which are designated as baby-
                                 friendly facilities according to BFHI criteria

 Sources of data:                Household surveys: MICS 1996 and MICS 2000

 Basic breastfeeding indicators: exclusive breastfeeding rate, timely complementary feeding and continued
 breastfeeding rate were calculated in MICS 2000. In order to measure progress between mid and end-decade
 (and evaluate BFHI programme as well) data from MICS 1996 were also used. The number of hospitals and
 maternity facilities designated as baby-friendly facilities according to BFHI criteria is provided from the
 UNICEF database - 24 out 69 maternities in the FRY have been certified as Baby-Friendly.

 Data on the current situation on breasfeeding, provided by MICS 2000, are presented in the following table:

 Table 26: Percent of children by breastfeeding status, FRY excluding Kosovo and Metohija, 2000

                           Exclusive        Timely complementary           Breastfed             Breastfed
                         breastfeeding             feeding
                                                                      Children Number       Children   Number
                     Children 0- Number of Children 6- Number of
Territory                                                              12-15     of          20-23        of
                      3 months children 9 months        children
                                                                      months children       months     children
FRY excl. K & M         10.6        109        33.2            125     20.8     121           10.8       118
Republic of
                        18.1         11        40.5             10      32.9        12         11.9          10
Montenegro
Republic of Serbia
                         9.7         98        32.6            115      19.5       109         10.7       108
excl. K & M
Central Serbia           6.3         75        34.8             90      20.3        86         14.9          77
Vojvodina               21.0         23        24.5             25      16.7        23           .0          31
Area
Urban                    9.9         70        33.2             72      19.6        73          4.1          66
Rural                   11.9         40        33.2             53      22.8        47         19.2          52
Gender
Male                    10.5         64        31.2             75      16.4        58          7.2          59
Female                  10.7         45        36.3             50      24.9        63         14.3          59
Mother’s
education
None/primary            11.3         27        23.1             22      23.3        33         30.5          26
Secondary                8.5         62        33.6             79      18.4        65          5.7          75
Higher/high             15.7         21        55.7             24      24.4        23          2.2          16




                                                      - 65 -
Trends in major breastfeeding indicators were presented in the figure 4:


                    Figure 4: Progress in major breastfeeding indicators
                                         1996-2000*


       100
        90
        80
        70
 Percent




        60
        50
        40
        30
        20
        10
         0
               Exclusive      Continued       Timely first   Breastfeeding   Predominant Bottle feeding
             breastfeeding   breastfeeding   suckling rate    on demand      breastfeeding    rate
                              rate 12-15                                          rate
                                months

                                                 1996        2000

* These increases are significant at confidence interval of 90%.




                                                         - 66 -
Goal 17: Growth promotion and its regular monitoring to be institutionalised in all countries by the end
of the 1990s


No specific indicator for monitoring of this indicator is specified. In the textual part of the report,
Growth monitoring in the country is described.




                                                 - 67 -
Goal 18: Dissemination of knowledge and supporting services to increase food production to ensure
household food security


No specific indicator has been selected to monitor this goal. The overall situation with respect to food
security is described in the textual part of the end-decade report.




                                                 - 68 -
Goal 19: Global eradication of poliomyelitis by the year 2000


Polio cases                    Annual number of cases of polio

Sources of data:               Routine reporting by Federal Institute of Public Health


Data on poliomyelitis are published annually in the Health Statistical Yearbooks by the Federal Institute of
Public Health, Belgrade.

The annual number of polio cases in the past decade is shown in table 27:

Table 27: Annual number of notified cases of polio (A80, ICD-X)

 Territory                       1990 1991 1992 1993              1994      1995   1996   1997   1998    1999
 FR Yugoslavia                     3      7      12      7         1          3     24      -       *       *
 Republic of Montenegro            -      -       -      -          -         -      -      -    -       -
 Republic of Serbia                3      7      12      7         1          3     24      -      **      **
  Central Serbia                   1      1       2      1          -         -      -      -    -       -
  Vojvodina                        -      -       -      -          -         -      -      -    -       -
   Kosovo and Metohija             2      6      10      6         1          3     24      -     NA      NA
* Data for FRY excluding Kosovo and Metohija
** Data for Republic of Serbia excluding Kosovo and Metohija




                                                    - 69 -
Goal 20: Elimination of neonatal tetanus by 1995

Neonatal tetanus cases         Annual number of cases of neonatal tetanus


Sources of data:               Routine reporting by Federal Institute of Public Health

Data on neonatal tetanus are published annually in the Health Statistical Yearbooks by the Federal Institute of
Public Health, Belgrade.

The annual number of neonatal tetanus cases in the past decade is shown in table 28:

Table 28: Annual number of notified cases of neonatal tetanus (A33, ICD-X)

 Territory                         1990    1991    1992    1993        1994     1995     1996     1997     1998
 FR Yugoslavia                       -       -       1       1          4        6         -        3      *
 Republic of Montenegro              -       -       -       -           -        -        -        -      -
 Republic of Serbia                  -       -       1       1          4        6         -        3      **
  Central Serbia                     -       -       1       1           -       3         -        -      -
  Vojvodina                          -       -       -       -          1         -        -        -      -
  Kosovo and Metohija                -       -       -       -          3        3         -        3       NA
* Data for FRY excluding Kosovo and Metohija
** Data for Republic of Serbia excluding Kosovo and Metohija




                                                    - 70 -
Goal 21: Reduction by 95 per cent in measles deaths and reduction by 90 per cent of measles cases
compared to pre-immunisation levels by 1995, as a major step to the global eradication of measles in the
longer run

Under-five deaths from        Annual number of under-five deaths due to measles
measles

Measles cases                 Annual number of cases of measles in children under five years of age


Sources of data:              Vital events registration system and routine health statistics


Data on measles mortality and morbidity are published annually in the Health Statistical Yearbooks by the
Federal Institute of Public Health, Belgrade.

The annual number of under-five deaths due to the measles is shown in table 29:


Table 29: Under five deaths due to measles, by territory

 Territory                    1990 1991       1992   1993    1994        1995     1996   1997   1998   1999
 FR              Total         14       -       -      4       -           -        -     2       *    *
 Yugoslavia      Male           5       -       -      1       -           -        -     1       *    *
                 Female         9       -       -      1       -           -        -     1       *    *
 Republic of     Total          -       -       -      -       -           -        -      -    -      -
 Montenegro      Male           -       -       -      -       -           -        -      -    -      -
                 Female         -       -       -      -       -           -        -      -    -      -
 Republic        Total         14       -       -      4       -           -        -     2       **   **
 of Serbia       Male           5       -       -      1       -           -        -     1       **   **
                 Female         9       -       -      3       -           -        -     1       **   **
 Central         Total          3       -       -      4       -           -        -      -    -      -
 Serbia          Male           1       -       -      1       -           -        -      -    -      -
                 Female         2       -       -      3       -           -        -      -    -      -
 Vojvodina       Total          -       -       -      -       -           -        -      -    -      -
                 Male           -       -       -      -       -           -        -      -    -      -
                 Female         -       -       -      -       -           -        -      -    -      -
 Kosovo          Total         11       -       -      -       -           -        -     2      NA     NA
 and Metohija    Male           4       -       -      -       -           -        -     1
                 Female         7       -       -      -       -           -        -     1
* Data for FRY excluding Kosovo and Metohija
** Data for Republic of Serbia excluding Kosovo and Metohija




                                                   - 71 -
The annual number of measles cases is presented in the following table:

 Table 30: Annual number of notified cases of measles (B05, ICD-X) in children under five years of age

 Territory                            1990    1991      1992    1993      1994    1995    1996    1997   1998
 FR Yugoslavia                        3217     463      1073    4608       262     124     161    2216    304
 Republic of Montenegro                203      54        18     531        22      18      50     164     80
 Republic of Serbia                   3014     409      1055    4077       240     106     111    2052    224
 Central Serbia                        292     287       129    1331       169      46      44      82    122
 Vojvodina                              51      29       160     419        35      28       1      10     30
 Kosovo and Metohija                  2671      93       766    2327       136      32      66    1960     72


The data over the decade are shown on the following graph:


           Figure 5: Annual number of notified cases of measles in children under
                                    five years of age


  5000
  4500
  4000
  3500
  3000
  2500
  2000
  1500
  1000
   500
      0
           1990    1991     1992    1993     1994     1995     1996    1997      1998    1999    2000




                                                     - 72 -
Goal 22: Maintenance of a high level of immunisation coverage (at least 90 per cent of children under
one year of age by the year 2000) against diphtheria, pertussis, tetanus, measles, poliomyelitis,
tuberculosis and against tetanus for women of child-bearing age

DPT immunisation                Proportion of one year old children immunised against diphtheria, pertussis
coverage                        tetanus (DPT)

Measles immunisation            Proportion of one year old children immunised against measles
coverage

Polio immunisation              Proportion of one year old children immunised against poliomyelitis
coverage

Tuberculosis                    Proportion of one year old children immunised against tuberculosis
immunisation coverage

Children protected              Proportion of one year old children protected against neonatal tetanus
against neonatal tetanus        through immunisation of their mother

Sources of data:                Household surveys: MICS 1996 and MICS 2000, and routine health
                                statistics


Vaccination coverage data are provided from two sources: routine health statistics and household surveys
(MIICS I and MICS II).

In routine statistics, the vaccination coverage rate is calculated as the number of vaccinated children divided
by the number of children planned for vaccination. The denominator is calculated at the municipality level.

A separate reporting system for BCG is in place, which has a lower reliability of data. The measles vaccination
rate is based on vaccination with MMR vaccine, which according to the national immunisation calendar, is
administered at the age of 12 to 18 months.

In household surveys data were calculated on the basis of the mother‟s statement, or data from a personal
vaccination card.

Data from MICS I and MICS II are presented on Table 31:

Table 31: Percentage of children 12-23 months immunised against childhood diseases in FR Yugoslavia
excluding Kosovo and Metohija

 Vaccine                MICS 1996         MICS 2000
 BCG                        99.4               98.0
 DPT3                       94.1               94.9
 OPV3                       92.5               98.0
 Measles (MMR)*             93.9               89.2
* The denominator used in the measles rate is children in the third year of life.




                                                      - 73 -
Data from routine health statistics are presented in the following tables:

Table 32: BCG vaccination coverage

Territory                       1990       1991      1992       1993         1994   1995   1996    1997
FR Yugoslavia                   78.6       81.8      76.7       67.9         70.8   70.9    83.9   64.1
Republic of Montenegro           100       98.3      92.0       90.0         96.2   94.9    93.5   90.9
Republic of Serbia              77.2       79.8      75.6       66.4         69.1    NA     83.2   62.2
Central Serbia                  93.4       89.3      93.3       82.1         89.7    NA    112.7   91.4
Vojvodina                       83.1       88.1      56.8       62.6         71.7    NA     60.7   59.1
Kosovo and Metohija             54.9       64.7      59.7       45.1         36.6    NA     51.9   25.1


Table 33: DPT3 vaccination coverage

Territory                       1990       1991      1992       1993         1994   1995   1996    1997
FR Yugoslavia                   84.0       78.9      84.2       84.6         85.0   89.0   91.2    94.0
Republic of Montenegro          82.9       79.5      78.9       79.9         87.1   91.2   91.2    94.5
Republic of Serbia              84.1       78.9      84.6       84.9         84.9   95.8   91.2    94.0
Central Serbia                  97.0       96.7      95.8       96.0         96.7   97.1   97.8    97.5
Vojvodina                       94.6       94.7      95.2       95.9         94.3   94.8   95.9    96.2
Kosovo and Metohija             64.8       55.7      70.1       71.5         79.3   78.0   81.7    89.3


Table 34: OPV3 vaccination coverage

Territory                       1990       1991      1992       1993         1994   1995   1996    1997
FR Yugoslavia                   80.7       80.5      84.4       82.5         84.4   89.5   91.1    94.0
Republic of Montenegro          82.1       81.2      79.0       78.8         85.6   89.6   97.0    95.6
Republic of Serbia              80.6       80.5      84.8       82.8         84.3   89.5   90.5    93.9
Central Serbia                  97.0       97.4      94.0       95.5         95.3   97.3   97.9    97.3
Vojvodina                       94.2       95.5      95.3       95.6         94.7   95.6   95.9    96.4
Kosovo and Metohija             58.7       58.5      72.8       69.6         79.0   79.8   80.6    89.3


Table 35: Measles (MMR) vaccination coverage

Territory                       1990       1991      1992       1993         1994   1995   1996    1997
FR Yugoslavia                   83.0       75.5      81.8       84.9         80.8   86.0   90.1    91.9
Republic of Montenegro          84.8       77.3      93.4       67.9         75.5   90.8   93.2    95.7
Republic of Serbia              82.8       75.3      81.5       86.3         81.3   85.6   89.8    91.6
Central Serbia                  95.9       91.1      94.1       95.5         89.2   93.3   96.9    96.8
Vojvodina                       96.9       95.0      95.9       96.8         92.5   95.5   96.5    97.7
Kosovo and Metohija             56.5       51.3      65.6       75.5         70.2   73.1   78.1    84.0




                                                      - 74 -
A summary of the data is shown in the following figure:

               Figure 6: Vaccination coverage against childhood diseases in FR Yugoslavia



                                     100
                                     95
              Vaccination coverage


                                     90
                                     85
                                     80
                                     75
                                     70
                                     65
                                     60
                                           1990   1991    1992      1993    1994   1995   1996   1997

                                                         DPT3        OPV3      Measles (MMR)

BCG vaccination rate in 1996 was 97.1 (MICS I).




                                                                 - 75 -
Goal 23: Reduction by 50 per cent in the deaths due to diarrhoea in children under the age of five years
and 25 per cent reduction in the diarrhoea incidence rate

Under five deaths             Annual number of under-five deaths due to diarrhoea
from diarrhoea

Diarrhoea cases               Average annual number of episodes of diarrhoea per child under five years of
                              age

ORT use                       Proportion of children 0-59 months of age who had diarrhoea in the last two
                              weeks who were treated with oral rehydration salts or an appropriate household
                              solution     (ORT)

Home management of            Proportion of children 0-59 months of age who had diarrhoea in the last
diarrhoea                     two weeks and received increased fluids and continued feeding during the
                              episode

Sources of data:              Vital registration system and household surveys: MICS I and MICS II

Two sources of data were used: vital events registration system for providing data for annual number of under
five deaths due to diarrhoea (ICD – 10th Revision, causes A00 – A09) and MICS 1996 and MICS 2000 for
providing data on number of diarrhoea cases, ORT use and home management of diarrhoea.

Annual number of deaths due to diarrhoea are shown at Table 36 and Figure 7:

Table 36: Under five deaths from diarrhoea (A00-A09)

Territory                        1990 1991 1992          1993    1994    1995    1996     1997 1998        1999
FR Yugoslavia     Total          258     398    373       320     229     221     163      138  33*         25*
                  Male           126     190    182       151     114     114      72       78  18*         16*
                  Female         132     208    191       169     115     107      91       60  15*          9*
Republic          Total            6      3      3          -      1       2       1        3     2      4
of                Male             2      2       -         -      1       1        -       2     2      4
Montenegro        Female           4      1      3          -       -      1       1        1     -      -
Republic          Total          252     395    370       320     228     219     162      135  31**       21**
of                Male           124     188    182       151     113     113      72       76  16**       12**
Serbia            Female         128     207    188       169     115     106      90       59  15**        9**
Central           Total            54     26     19        33      36      34      29       14 28        17
Serbia            Male             28     13     9         13      19      21      11       6  15        10
                  Female           26     13     10        20      17      13      18       8  13        7
Vojvodina         Total            2      1      2         7        -      2       3        12    3      4
                  Male             1       -      -        4        -       -      2        9     1      2
                  Female           1      1      2         3        -      2       1        3     2      2
Kosovo            Total          196     368    349       280     192     183     130      109  NA          NA
and               Male             95    175    173       134      94      92      59       61  NA          NA
Metohija          Female         101     193    176       146      98      91      71       48  NA          NA
* Data for FRY excluding Kosovo and Metohija
** Data for Republic of Serbia excluding Kosovo




                                                   - 76 -
                  Figure 7: Under five deaths from diarrhoea in FR Yugoslavia

 450
 400
 350
                                                                          y = -30.5x + 399.75
 300
 250
 200
 150
 100
  50
   0
         1990    1991     1992    1993     1994       1995     1996    1997   1998   1999    2000

                              Total        Male         Female          Linear (Total)


Proportion of children under five years of age who had diarrhoea in the last two weeks and who were treated
with oral rehydration salt or an appropriate household solution are shown in table 37. In order to enable
measurements of trends, data from MICS 1996 were recalculated for FRY excluding Kosovo and Metohija:

Table 37: ORT use (pre-1993 ORT definition)

Territory                                MICS I              MICS II
FRY excl. K & M                            96.7                97.9
Republic of Montenegro                    100.0               100.0
Republic of Serbia excl. K & M             96.4                97.8
Central Serbia                             95.2                98.3
Vojvodina                                 100.0                96.8
Area
Urban                                     100.0               100.0
Rural                                      93.1                96.2


The home management of diarrhoeal diseases, is presented in the following table:

Table 38: Home management of diarrhoea, MICS 1996

Territory                              Home management
FR Yugoslavia                                41.3
Republic of Montenegro                       54.8
Republic of Serbia                           40.6
Central Serbia                               52.3
Vojvodina                                    31.6
Kosovo and Metohija                          35.5
Area
Urban                                          49.4
Rural                                          36.7




                                                   - 77 -
Goal 24: Reduction by one third in the deaths due to acute respiratory infections in children under five
years

Under-five deaths from         Annual number of under-five deaths due to acute respiratory infections
acute respiratory infections   (ARI)

Care seeking for acute         Proportion of children 0-59 months of age who had ARI in the last two
respiratory infections         weeks and were taken to an appropriate health provider

Sources of data:               Household survey MICS 2000 and vital registration system


Two sources of data were used: vital events registration system for providing data for annual number of under
five deaths due to acute respiratory infections (ICD – 10th Revision, causes J00 – J98) and MICS 1996 and
MICS 2000 for providing data on number of acute respiratory infections (ARI) and home management of ARI.

Annual number of deaths due to ARI are shown at Table 39 and Figure 8:

Table 39: Under five deaths from acute respiratory infections (J00-J98)

Territory                          1990 1991 1992           1993   1994    1995    1996    1997    1998    1999
FR Yugoslavia       Total           526    446  406          367    277     252     213     189     47*     37*
                    Male            255    257  203          202    151     140     109      98     26*     15*
                    Female          271    189  203          165    126     112     104      91     21*     22*
Republic of         Total              9     3    5            6      4       2       3       2        -      4
Montenegro          Male               2     2    1            2      4       2       1       1        -      1
                    Female             7     1    4            4       -       -      2       1        -      3
Republic of         Total           517    443  401          361    273     250     210     187    47**    33**
Serbia              Male            253    255  202          200    147     138     108      97    26**    14**
                    Female          264    188  199          161    126     112     102      90    21**    19**
Central Serbia      Total            77     71   78           73     78      40      58      38       35     25
                    Male             40     31   39           43     40      18      31      20       20     12
                    Female           37     40   39           30     38      22      27      18       15     13
Vojvodina           Total            27     10   19           19     19      20      27      12       12      8
                    Male             15      7   10           11      9      12      12       7        6      2
                    Female           12      3    9            8     10       8      15       5        6      6
Kosovo              Total           413    362  304          269    176     190     125     137      NA     NA
and                 Male            198    217  153          146     98     108      65      70      NA     NA
Metohija            Female          215    145  151          123     78      82      60      67      NA     NA
* Data for FRY excluding Kosovo and Metohija
** Data for Republic of Serbia excluding Kosovo




                                                   - 78 -
                   Figure 8: Under five deaths from acute respiratory infections in
                                           FR Yugoslavia

   600
   500
                                                                          y = -48.524x + 552.86
   400
   300
   200
   100
     0
            1990   1991    1992      1993   1994     1995    1996     1997    1998      1999   2000

                               Total        Male        Female        Linear (Total)



Proportion of under five children who had ARI in the last two weeks and were taken to an appropriate health
provider is presented in the following table:

Table 40: Proportion of under five children who had ARI in the last two weeks, MICS 2000

Territory                                       Had ARI in %             Appropriate health
                                                                           provider (%)
FRY excluding K & M                                   2.7                      96.7
Republic of Montenegro                                2.1                     100.0
Republic of Serbia excluding K & M                    2.7                      96.4
Central Serbia                                        2.7                      95.0
Vojvodina                                             3.1                     100.0
Area
Urban                                                 3.2                        95.4
Rural                                                 1.9                       100.0
Gender
Male                                                  3.0                       100.0
Female                                                2.3                        92.1
Mother’s education
None/primary                                          0.7                       100.0
Secondary                                             3.4                        95.7
Higher/high                                           5.2                       100.0




                                                   - 79 -
Goal 25: Elimination of guinea-worm (dracunculiasis) by the year 2000

Dracunculiasis cases         Annual number of cases of dracunculiasis (guinea-worm) in the total
                             population


This goal is not applicable to FR Yugoslavia.




                                                - 80 -
Goal 26: Expansion of early childhood development activities, including appropriate low-cost family
and community-based interventions

Pre-school development      Proportion of children aged 36-59 months who are attending some form of
                            organised early childhood education programme

Underweight prevalence      Proportion of under-fives who fall below minus 2 standard deviations from
                            median weight for age of NCHS/WHO reference population


Sources of data:              Administrative data and household surveys (MICS 1996; MICS 2000)


The calculation of the pre-school development indicator two sources of data were used: administrative data
and data from MICS 2000.

Underweight prevalence in children under five years age is calculated from MICS 1996 and MICS 2000 data
and is presented in the third chapter (Goal 3).

Proportion of children aged 36-59 months who are attending some form of organised early childhood
education programme in FR Yugoslavia calculated from administrative are presented in the following table:

Table 41: Proportion of children aged 36-59 months who are attending some form of organised early
childhood education programme in FR Yugoslavia

 Territory                  1990    1991     1992     1993     1994    1995    1996     1997     1998    1999
 FR             Total        17.0    15.5    16.4     10.3      13.3    15.9   17.5     23.0    25.5*   25.5*
 Yugoslavia     Male         16.9    15.6    16.6     10.3      13.2    16.0   17.4     22.9    25.5*   23.7*
                Female       17.0    15.5    16.3     10.3      13.4    15.9   17.6     23.2    25.4*   27.4*
 Republic of    Total        19.2    14.4    16.0     15.0      17.0    22.4   20.1     19.8    21.8    21.8
 Montenegro     Male         19.1    14.1    16.0     14.7      17.1    23.2   20.8     20.0    22.3    19.7
                Female       19.2    14.7    16.0     15.4      16.9    21.6   19.4     19.5    21.3    24.0
 Republic of    Total        16.8    15.6    16.5     10.0      13.0    15.5   17.3     23.3     NA      NA
 Serbia         Male         16.8    15.7    16.7     10.0      12.9    15.5   17.1     23.1     NA      NA
                Female       16.8    15.5    16.3     10.0      13.1    15.5   17.4     23.4     NA      NA
 Central        Total        25.2    24.3    21.9     14.7      19.2    22.9   24.6     30.1    25.6    25.6
 Serbia         Male         25.3    24.4    22.2     14.8      19.1    22.9   24.5     30.0    25.5    23.8
                Female       25.1    24.2    21.6     14.7      19.4    22.8   24.7     30.2    25.6    27.4
 Vojvodina      Total        19.9    20.3    33.7     16.1      21.5    23.8   25.0     40.7    26.7    26.7
                Male         20.0    20.5    34.6     16.6      22.0    24.4   25.0     40.4    27.0    25.1
                Female       19.8    20.2    32.7     15.6      21.0    23.1   25.0     41.0    26.5    28.5
 Kosovo and     Total         3.5     1.8     1.8       1.2      1.4     1.8     2.7      4.1    NA      NA
 Metohija       Male          3.4     1.8     1.8       1.2      1.4     1.8     2.7      4.2    NA      NA
                Female        3.5     1.8     1.8       1.2      1.3     1.8     2.7      4.0    NA      NA
* Data for FRY excluding Kosovo and Metohija




                                                  - 81 -
More recent data, from the MICS 2000 are presented in the Table 42:

Table 42: Percentage of children aged 36-59 months who are attending some form of organised early
childhood education programmed

 Territory                                                 Attending programme   Number of children
 FR Yugoslavia excl. Kosovo and Metohija                             31.4               673
 Republic of Montenegro                                              32.3                68
 Republic of Serbia excluding Kosovo and Metohija                    31.3               605
 Central Serbia                                                      30.6               460
 Vojvodina                                                           33.6               145
 Gender
 Male                                                                 34.4               334
 Female                                                               28.5               340
 Age
 36 – 47 months                                                       24,2               325
 48 – 59 months                                                       38.1               348
 Area
 Urban                                                                44.7               401
 Rural                                                                11.9               272
 Mother’s education
 None/primary                                                         29.5               212
 Secondary                                                            30.0               407
 Higher/high                                                          49.9               55




                                                  - 82 -
Goal 27: Increased acquisition by individuals and families of the knowledge, skills and values required
for better living, made available through all educational channels, including the mass media, other
forms of modern and traditional communication and social action, with effectiveness measure in terms
of behavioural change


No specific indicators at the national level.




                                                - 83 -
Additional indicators for monitoring children’s rights:

Birth registration           Proportion of children 0-59 months of age whose births are reported registered

Children’s living            Proportion of children 0-14 years of age in households not living with
arrangements                 biological parent

Orphans in household         Proportion of children 0-14 years of age who are orphans living in households

Child labour                 Proportion of children 5-14 years of age who are currently working (paid or
                             unpaid; inside or outside home)


These indicators are not routinely calculated and published in routine statistics, neither reliable data
source was available.




                                                  - 84 -
Additional indicators for monitoring the Integrated Management of Child Illness (IMCI) and malaria:

Home management                Proportion of children 0-59 months of age reported ill during the last two of
illness                        weeks who received increased fluids and continued feeding

Care seeking knowledge         Proportion of caretakers of children 0-59 months of age who know at least 2 of
                               the following signs for seeking care immediately: child not able to drink or
                               breastfeed, child becomes sicker, child develops a fever, child has fast
                               breathing, child has difficulty breastfeeding, child has blood in stools, child is
                               drinking poorly

Bednets                        Proportion of children 0-59 months of age who slept under and insecticide-
                               impregnated bednet during the previous night

Malaria treatment              Proportion of children 0-59 months of age who were ill with fever (in malaria
                               risk areas) in the last two weeks who received anti-malarial drugs


Sources of data:               Household survey MICS 2000


Home management of illnesses could not be provided from MICS 2000 data for two reasons. The question on
home management did not separate drinking more fluids during the illness from drinking the same quantity of
fluids, so calculating the indicator (increased intake of fluid) was not possible. There was also a high number
of 'do not know' answers. Care seeking knowledge was calculated from MICS 2000 data.

Indicators on malaria were not calculated, since malaria was eradicated in the FR Yugoslavia in „60s.




                                                    - 85 -
 Home management of children under five who reported ill in the last two weeks are presented at the table 43.

     Table 43: Home management of children 0-59 months of age reported ill during the last two weeks

   Territory            Reported Number          Drinking           Total Eating during illness Total       Number
                        illness in  of         during illness                                                of sick
                        last two children      More/     Les               More/same        Less            children
                          weeks under 5        same       s
   FRY excl. K & M         27.9    1654        96.9      3.1        100       63.1          36.9     100          461
   R. of Montenegro        18.6     158        95.0      5.0        100       63.5          36.5     100           29
   R Serbia excl. K &      28.9    1496        97.1      2.9        100       63.1          36.9     100          315
   M
   Central Serbia         28.2        1117     97.9        2.1      100       69.3          30.7     100          315
   Vojvodina              30.9         378     94.8        5.2      100       39.8          60.2     100          117
   Area
   Urban                  28.6         971     96.0        4.0      100       61.0          39.0     100          278
   Rural                  26.9         683     98.4        1.6      100       66.5          33.5     100          183
   Gender
   Male                   28.1         853     98.0        2.0      100       56.0          44.0     100          240
   Female                 27.7         800     95.7        4.3      100       69.9          30.1     100          222
   Age
   < 6 months             17.6         142     100.0       0.0      100       72.2          27.8     100           25
   6-11 months            18.4         175      89.7      10.3      100       55.7          44.3     100           32
   12-23 months           32.8         341      95.2       4.8      100       70.5          29.5     100          112
   24-35 months           29.0         322      97.8       2.2      100       58.2          41.8     100           93
   36-47 months           33.1         325      98.2       1.8      100       67.3          32.7     100          108
   48-59 months           26.2         348      99.3       0.7      100       52.8          47.2     100           91
   Mother’s education
   None/primary           29.9         540      96.8       3.2      100       65.1          34.9     100          161
   Secondary              26.7         995      96.6       3.4      100       65.5          34.5     100          266
   Higher/high            28.9         119     100.0       0.0      100       27.7          72.3     100           34

 The knowledge of caretakers of children under five about the signs for seeking care immediately is shown at
 table 44.

 Table 44: Percentage of caretakers of children 0-59 months who know at least 2 signs for seeking care
 immediately, FRY excluding Kosovo and Metohija, 2000

               Not able                                   Has       Has       Is    Knows at Number
                          Becomes Develops a Has fast
Territory       to drink/                               difficult blood in drinking least two of care
                           sicker   fever    breathing
               breastfed                               breathing stool      poorly    signs   takers
FRY excl.
                 27.9      33.4      68.7        23.4            38.3     43.5       8.1           57.8    1654
K&M
Area
Urban            28.4      33.1      70.7        22.7            39.7     46.3       7.6           59.5     971
Rural            27.2      33.8      65.8        24.4            36.2     39.6       8.9           55.5     683
Gender
Male             30.4      34.9      69.2        25.8            39.6     42.6       8.5           58.1     853
Female           25.3      31.7      68.1        20.9            36.9     44.5       7.7           57.6     800
Mother’s
education
None/primary     27.7      31.6      65.5        21.1            36.7     40.3        7.3          53.9     540
Secondary        27.1      34.6      70.9        24.2            39.0     45.1        8.3          59.4     995
Higher/high      35.6      31.1      64.6        27.1            38.8     45.0       10.4          62.5     119




                                                       - 86 -
Indicators for monitoring HIV/AIDS:


Knowledge of preventing     Proportion of women who correctly state the three main ways of avoiding
HIV/AIDS                    HIV infection

Knowledge of                Proportion of women who correctly identify three misconceptions about
HIV/AIDS                    HIV/AIDS

Knowledge of mother to      Proportion of women who correctly identify means of transmission of child
transmission of HIV         HIV from mother to child

Attitude to people with     Proportion of women expressing a discriminatory attitude towards people
HIV/AIDS                    with HIV/AIDS

Women who know where        Proportion of women who know where to get a HIV test
to be tested for HIV

Women who have been         Proportion of women who have been tested for HIV
tested for HIV

Attitude toward condom      Proportion of women who state that it is acceptable for women in their areas to
                            ask a use man to use a condom

Adolescent sexual           Median age of girls/women at first pregnancy
behaviour


Sources of data:            Household survey MICS 2000


MICS 2000 included HIV/AIDS module. This was the first national survey on indicators for monitoring
HIV/AIDS.




                                                - 87 -
All indicators are presented in the following tables:

Table 45: Percentage of women aged 15-49 who knows the main ways of preventing HIV transmission

Territory              Heard Have only Using a Abstaining Knows Knows at Doesn't Number of
                         of  one faithful condom  from sex all three least one know any women
                       AIDS uninfected every time            ways       way      way
                             sex partner
FRY excl. K & M         91.7       62.6      60.1     27.6     21.9      74.9      25.1   4517
Republic of             86.5       57.0      47.9     27.6     21.0      66.1      33.9    312
Montenegro
Republic of Serbia       92.0          63.0       61.0           27.6   22.0   75.5   24.5        4205
excl K & M
 Central Serbia          91.9          62.8       59.7           28.3   22.4   75.1   24.9        3084
 Vojvodina               92.4          63.7       64.6           25.6   20.7   76.9   23.1        1121
Area
Urban                    92.4          65.3       64.3           27.4   21.7   78.7   21.3        2537
Rural                    90.7          59.1       54.6           27.8   22.2   70.0   30.0        1980
Age
15-19                    90.9          54.6       60.2           25.0   15.8   73.0   27.0         506
20-24                    92.3          61.6       64.9           25.3   19.5   78.9   21.1         600
25-29                    93.1          66.6       62.9           30.7   26.7   78.1   21.9         771
30-34                    91.0          66.3       60.0           24.8   19.9   77.7   22.3         702
35-39                    91.9          66.8       60.6           28.2   22.9   76.6   23.4         592
40-44                    92.3          62.8       59.9           29.2   24.2   73.5   26.5         658
45-49                    89.9          57.4       52.3           28.7   22.2   66.1   33.9         687
Mother’s education
None/elementary          88.0          54.6       50.6           27.0   20.7   64.4   35.6        1278
Secondary                92.5          64.1       60.4           27.8   22.0   76.6   23.4        2404
Higher/high              94.8          70.6       73.6           27.6   23.6   86.1   13.9         836




                                                        - 88 -
Table 46: Percentage of women aged 15-49, who correctly identifies misconceptions about HIV/AIDS

 Territory          Heard Know AIDS         Know a     Identify two  Identify at     Doesn't     Number
                      of can't be           healthy misconceptions least one        correctly      of
                    AIDS transmitted by     looking                 misconception identify any   women
                          mosquito bites' person can                             misconception
                                          be infected'
 FRY excl. K & M 91.7          38.0           62.7        32.3          68.3          31.7         4517
 Republic of         86.5      28.2           53.9        22.2          59.8          40.2          312
 Montenegro
 Republic of Serbia 92.0       38.7           63.4        33.1          69.0          31.0         4205
 excl. K & M
 Central Serbia      91.9      37.7           62.2        32.2          67.7          32.3         3084
 Vojvodina           92.4      41.4           66.5        35.5          72.4          27.6         1121
 Area
 Urban               92.4      43.3           68.1        37.1          74.3          25.7         2537
 Rural               90.7      31.2           55.8        26.2          60.7          39.3         1980
 Age
 15-19               90.9      42.2           63.6        34.1          71.7          28.3          506
 20-24               92.3      42.8           66.9        38.1          71.6          28.4          600
 25-29               93.1      37.6           65.5        32.4          70.7          29.3          771
 30-34               91.0      38.2           67.9        34.6          71.5          28.5          702
 35-39               91.9      39.1           63.2        32.6          69.6          30.4          592
 40-44               92.3      36.9           60.2        30.6          66.6          33.4          658
 45-49               89.9      30.7           51.9        24.9          57.7          42.3          687
 Mother’s
 education
 None/primary        88.0      28.2           49.1        22.0          55.4          44.6         1278
 Secondary           92.5      36.9           63.2        31.5          68.7          31.3         2404
 Higher/high         94.8      55.7           81.9        50.5          87.1          12.9          836




                                               - 89 -
Table 47: Percentage of women aged 15-49 who correctly identifies means of HIV transmission from
mother to child

Territory          Know AIDS Transmission Transmissio Transmissio Knows      Did not      Number
                       can be     during       n       n through all three    know          of
                    transmitted pregnancy      at        breast            any specific   women
                   from mother   possible   delivery milk possible             way
                      to child              possible
FRY excl. K & M         61.1       64.5       50.6        37.3     31.4        31.1       4517
Republic of             56.7       57.2       44.3        34.3     29.6        39.7        312
Montenegro
Republic of Serbia      61.5       65.1       51.1        37.6     31.5        30.4       4205
excl. K & M
 Central Serbia         60.9       63.7       51.4        40.4     34.0        31.7       3084
 Vojvodina              63.0       69.0       50.1        29.6     24.6        26.8       1121
Area
Urban                   65.7       70.4       53.8        37.7     31.3        25.2       2537
Rural                   55.2       57.0       46.4        36.9     31.5        38.6       1980
Age
15-19                   54.7       60.5       43.0        36.6     25.7        32.1        506
20-24                   62.4       67.4       50.4        40.7     33.9        28.9        600
25-29                   65.7       67.4       52.8        37.8     32.2        27.9        771
30-34                   63.2       67.8       54.7        37.9     32.4        27.5        702
35-39                   62.9       68.2       54.9        39.1     34.2        28.0        592
40-44                   61.4       65.1       50.5        38.0     32.4        31.9        658
45-49                   55.6       54.8       46.0        31.8     28.0        41.3        687
Mother’s
education
None/primary            50.1       52.1       41.4        35.7     30.7        44.3       1278
Secondary               61.7       65.8       51.2        37.5     31.3        29.6       2404
Higher/high             76.4       79.9       62.9        39.2     32.6        15.0        836




                                             - 90 -
Table 48: Percentage of women aged 15-49 who expresses a discriminatory attitude towards people with
HIV/AIDS

Territory                     Believe that a Would not buy Agree with at    Agree with      Number
                              teacher with    food from a     least one        neither        of
                             HIV should not person with    discriminatory discriminatory    women
                              be allowed to    HIV/AIDS       statement      statement
                                  work
FRY excl. K & M                  25.2           17.2           29.1           70.9            4517
Republic of Montenegro           17.6           13.3           21.3           78.7             312
Republic of Serbia excl. K &     92.0           22.0           33.1           10.3            4205
M
 Central Serbia                  25.3           17.4           29.3           70.7            3084
 Vojvodina                       27.1           17.7           30.6           69.4            1121
Area
Urban                            29.4           19.3           33.3           66.7            2537
Rural                            19.8           14.5           23.7           76.3            1980
Age
15-19                            26.0           15.1           29.5           70.5             506
20-24                            32.2           22.4           36.1           63.9             600
25-29                            24.8           19.1           30.4           69.6             771
30-34                            26.8           18.9           30.2           69.8             702
35-39                            24.0           14.8           26.5           73.5             592
40-44                            23.7           16.6           28.5           71.5             658
45-49                            20.1           12.9           22.9           77.1             687
Mother’s education
None/primary                     16.2           11.3           19.2           80.8            1278
Secondary                        25.6           17.5           29.7           70.3            2404
Higher/high                      37.8           25.4           42.6           57.4             836




                                                - 91 -
Table 49: Percentage of women aged 15-49 who know where to get an AIDS test and who has been
tested, FRY excluding Kosovo & Metohija, 2000

Territory                        Know a place to Have been tested If tested, have    Number of
                                   get tested                     been told result    women
FRY excl. K & M                      44.9              5.9              85.4          4517
Republic of Montenegro               33.7              2.4              75.9           312
Republic of Serbia excl. K & M       45.8              6.2              85.7          4205
 Central Serbia                      47.4              6.9              86.3          3084
 Vojvodina                           41.4              4.0              82.5          1121
Area
Urban                                 52.8              7.8             90.7          2537
Rural                                 34.9              3.5             70.0          1980
Age
15-19                                 39.6              1.9             63.6           506
20-24                                 45.3              6.8             86.0           600
25-29                                 48.7              8.3             96.6           771
30-34                                 51.8              8.4             83.1           702
35-39                                 48.4              5.1             89.1           592
40-44                                 41.3              5.3             73.7           658
45-49                                 38.0              4.1             81.7           687
Mother’s education
None/elementary                       27.4              3.6             56.4          1278
Secondary                             46.8              6.2             90.6          2404
Higher/high                           66.5              8.4             93.5           836




                                              - 92 -