SITUATION OF CHILDREN IN PerU

SITUATION OF CHILDREN IN PerU executive SUMMARY

Index INTRODUCTIOn... 1 SituaTIOn OF CHILDREN AND adolescents... 2 EARLY CHILDHOOD (FROM CONCEPTION THROUGH 5 YEARS)... 4 CHILDHOOD (FROM 6 TO 11 YEARS)... 1 adolescence (FROM 12 TO 17 YEARS)... 15 TABLES Indicators of the situation of children and adolescents by life cycle... 3 Summary of departmental indicators... 21 Situation of Children in Peru. Executive Summary United Nations Children s Fund (UNICEF) Parque Melitón Porras 35, Miraflores, Lima Peru Phone: 21377 / Fax: 44737 Web page: www.unicef.org/peru Instituto Nacional de Estadística e Informática (INEI) General Garzón 654 658, Jesús María, Lima Peru Phone: 4334223 / Fax: 431134 Web page: www.inei.gob.pe Placed in Legal Deposit with the Biblioteca Nacional del Perú No. 28-6626 First edition 1, copies Lima, June 28 Printed in Tarea Asociación Gráfica Educativa Cover photo: UNICEF/PERA/26/Ouvrard Back cover photo: UNICEF/PERA-9143 Maps of Peru and its departments: Instituto Nacional de Estadística e Informática Dirección Nacional de Censos y Encuestas Dirección Ejecutiva de Cartografía y Geografía Design and diagramming: Gisella Scheuch This document may be copied and cited totally or partially, as long as the source is mentioned. Please send us a copy of any document, article or other publication that cites this publication.

INTRODUCTION UNICEF/PERA/26/Ouvrard Peru has made important steps towards increasing norms, policies and programmes that promote and protect the rights of children. However, because Peru is a country with great cultural, ethnic, linguistic, socio-economic and geographic diversity, national averages tend to hide the real situation of inequity in which many children and adolescents live. Because of this, it is necessary to have disaggregated information, particularly in regards to different regions of the country. It is in this context that the study entitled Situation of Children in Peru has been prepared. This document aims to better inform policy makers and the public about the situation of Peruvian children and adolescents at the national, regional and local levels. Further, it aims to contribute to the formulation of public policies to better fulfil the rights of all children and adolescents in Peru. This study presents analytical information about Peruvian young people by stages in their life cycle: early childhood (from conception through 5 years); childhood (ages 6 to 11 years) and adolescence (ages 12 and 17 years). Each of the stages includes: a) The Child Development Index (CDI), which shows the processes that limit or empower the integral development of children and adolescents, including the dimensions of (1) health and nutrition; (2) learning and education; and (3) environment and the protection of rights. b) Information on indicators for children and adolescents, disaggregated by geographic regions, areas of residence, socio-economic levels, maternal language and gender. This study also addresses the situation of children and adolescents by regions, with information disaggregated at the provincial level in order to show the existing differences within each region. The following text provides a summary of the main aspects of the study entitled Situation of Children in Peru. Situation of Children in Peru 1

Situation of children and adolescents UNICEF/PERA/27 Peru s total population currently exceeds 28 million people. 38% of the total population is comprised of children and adolescents between and 17 years (1,73,85), and around 6% of this population live in conditions of poverty. Population in Peru, by age group Population by age group National % of the total population Total population 28,348,7 1. Child and adolescent population 1,73,85 37.9 Children -5 3,585,977 12.7 Children 6-11 3,618,869 12.8 Adolescents 12-17 3,525,959 12.4 Source: Peru: Estimations and Projections of Population: Rural, Urban, Total per Calendar years and Simple Ages 197 225. Special Bulletin No. 15, July 22 (INEI). Children and adolescents constitute one of the most vulnerable sectors of the population. As shown in the following figure, children and adolescents are the group most affected by poverty. While 45% of Peru s total population live in conditions of poverty, 6% of children between the ages of and 5 years are poor, and 58% of children between the ages of 6 and 11 years are poor. In other words, the poverty rate for children is approximately 15 percentage points higher than the poverty rate for the overall population. The situation of children living in extreme poverty is also startling, with rates reaching 27% for children ages to 5 years and 24% of children ages 6 and 11 years. This means that the rate Figure 1 Rates of poverty and extreme poverty in children and adolescents of children in Peru living in extreme poverty are about 1 percentage points higher than the extreme poverty rate for the total population (16%). The main indicators for the situation of children and adolescents in Peru are presented below by stages in their life cycle. The study includes disaggregated analysis based on the factors such as areas of residence, maternal language and regional differences all contributing to the current inequality within the country. 75 6 45 3 15 Total population 45 Children to 5 6 58 Poverty 52 source: Based on ENAHO 26, INEI. Children 6 to 11 16 27 Adolescents 12 to 17 24 18 Extreme poverty 2 Executive Summary

Indicators of the situation of children and adolescents, by life cycle Indicator National Urban Rural Early childhood (from conception to 5 years) Prenatal care by health professionals 1a/ 91 % 97 % 83 % Birth attended by health professionals 1a/ 71 % 92 % 45 % Infant mortality (per thousand live births) 1b/ 21 17 27 Mortality in children under five years (per thousand live births) 1b/ 29 22 39 Chronic malnutrition rate in children under 5 years 2/ 27 % 18 % 33 % Proportion of children under 5 years with anaemia 2/ 5 % 47 % 54 % Rate of attendance in preschool for children ages 3 to 5 years 3/ 67 % 76 % 56 % Proportion of children between one month and 5 years lacking birth certificates 4/ 7 % 5 % 1 % Childhood (ages 6 to 11 years) Proportion of children ages 1 to 14 years with anaemia 2/ 32 % 27 % 35 % Net enrolment of primary education in children ages 6 to 11 years 3/ 93 % 94 % 92 % Percentage of children ages 6 to 11 years enrolled in a grade that does not correspond to their age 3/ 23 % 15 % 34 % Proportion of 6th grade children with mathematic skills below the basic level for their corresponding grade 5/ 58 % 6/ 55 % 7/ 83 % 7/ Proportion of 6th grade children with communication skills below the basic level for their corresponding grade 5/ 6 % 6/ 56 % 7/ 86 % 7/ Rate of children ages 6 to 11 years that work and study 3/ 18 % 5 % 35 % Adolescence (ages 12 to 17 years) Anaemia in adolescents ages 15 to 19 years 2/ 35 % 31 % 39 % Percentage of adolescents ages 15 to 19 years that do not know how to prevent the HIV/AIDS virus 1c/ 34 % Net secondary education enrolment in adolescents between ages 12 and 16 years 3/ 73 % 84 % 56 % Percentage of adolescents between 12 and 16 years enrolled in a grade that does not correspond to their age 3/ 41 % 3 % 6 % Proportion of adolescents in 5th grade of secondary school with mathematic skills below the basic level for their corresponding grade 5/ 86 % 6/ 92 % 7/ 98 % 7/ Proportion of adolescents in 11th grade with communication skills below the basic level for their corresponding grade 5/ 45 % 6/ 48 % 7/ 74 % 7/ Proportion of adolescents between ages 14 and 17 years who work when school is in session 3/ 5 % 32 % 8 % Proportion of female adolescents between ages 15 and 2 years that have experienced early maternity and childbirth 4/ 13 % 1 % 2 % 1a/ ENDES 24-26 report, INEI. 1b/ ENDES 24-26 report, INEI. The information on infant and child mortality is based on reports from 5 years prior to the survey. 1c/ ENDES 24-26 report, INEI. 25% of these adolescents have heard of HIV/AIDS, but do not know ways of preventing it. 9% report never having heard of HIV/AIDS. 2/ MONIN 24, INS - CENAN. 3/ Based on ENAHO 26, INEI. 4/ Based on ENCO 26. The definition of rural area in ENCO 26 is more restricted than the one in ENAHO 26. (See Annex 1). 5/ National Student Achievement Evaluation 24 MED. 6/ The national data include the results of students in State and non-state schools. 7/ The urban/rural data only includes the results from students enrolled in State school. Situation of Children in Peru 3

Early Childhood (from conception to 5 years) UNICEF/PERA/22 Early childhood is a fundamental stage in the growth 1 and development 2 of all human beings. Growth and development are interdependent, and the most critical stage occurs between conception and the first years of life a period when the brain is formed and develops at its fastest rate. If the adequate development of the brain is altered during this period, it will produce consequences that affect the child throughout his or her life. In recent years, Peru has made important advances towards improving the health situation for those in early childhood. According to the Demographic and Health Survey (DHS), prenatal care and attended deliveries have significantly increased during the last decade, and infant and child mortality rates have greatly reduced. Figure 2 Births attended by health professionals 1 National Urban Rural 8 6 4 2 DHS 1996 DHS 24-26 Source: Based on the DHS 1996 and DHS 24-26 reports, INEI. 1 Growth refers to the body height and weight and organs. 2 Development has to do with the programming and maturation of brain functions. 4 Executive Summary

Map 1 The Child Development Index for early childhood TUMBES LORETO PIURA Region CDI Group Callao.85 Tumbes.82 Lima.81 Tacna.81 Ica.8 Moquegua.78 Arequipa.72 Lambayeque.66 Madre de Dios.63 Piura.62 Puno.6 Junín.6 La Libertad.59 Pasco.59 Ancash.59 San Martín.58 Ucayali.57 Amazonas.56 Apurímac.55 Loreto.55 Cusco.53 Ayacucho.49 Cajamarca.49 Huánuco.46 Group 2:.62 -.72 Huancavelica.42 Group 3:.59 -.6 AMAZONAS LAMBAYEQUE CAJAMARCA 1 SAN MARTÍN LA LIBERTAD ANCASH UCAYALI HUÁNUCO 2 PASCO LIMA JUNÍN CALLAO MADRE DE DIOS 3 HUANCAVELICA ICA CUSCO APURÍMAC AYACUCHO PUNO 4 AREQUIPA MOQUEGUA TACNA 5 Source: Based on ENCO 26, ENAHO 26 and DHS 24-26 (INEI and MONIN 24 of CENAN). Group 1: Greater or equal to.78 Group 4:.55 -.58 Group 5: Lower or equal to.53 Concerning the relative situation between regions in regards to childhood growth and development among children ages to 5 years, it can be observed that Lima and Callao, as well as other coastal regions such as Ica, Tacna, Tumbes and Moquegua, are among the regions with the best relative performance in the CDI for early childhood. The Andean regions, such as Cusco, Ayacucho, Cajamarca, Huánuco and Huancavelica are the regions with the weakest relative indicators. Graph 3 shows that the central and southern sierra regions tend to fall into the last places on the Child Development Index (CDI) scale, which is consistent with their relative positions in terms of those living in poverty and extreme poverty. Situation of Children in Peru 5

UNICEF/PERA-9276 Nationally, the proportion of pregnant women who attended at least one prenatal check-up increased from 67% in 1996 to 91% in 24-26, and the deliveries attended by health professionals rose from 56% to 71% during the same period. However, the following graph shows that there are certain regions where around 6% of births are not attended by health professionals, such as Huancavelica (59%), Cajamarca (59%) and Amazonas (57%). Figure 3 Births NOT attended by health professionals (doctor, midwife or nurse) Of the total number of births taking place between 24 and 26 1 75 5 25 Cajamarca Huancavelica Amazonas Loreto Puno Huánuco Ancash Cusco La Libertad Junín San Martín Ucayali Ayacucho Pasco Apurímac Piura Lambayeque Madre de Dios Arequipa Tumbes Tacna Moquegua Lima Ica Callao Huancavelica 59 Cajamarca 59 Amazonas 57 Loreto 56 Puno 53 Huánuco 49 Ancash 46 Cusco 41 La Libertad 36 Junín 33 San Martín 32 Ucayali 29 Ayacucho 27 Pasco 27 Apurímac 24 Piura 24 Lambayeque 21 Madre de Dios 18 Arequipa 17 Tumbes 9 Tacna 7 Moquegua 6 Lima 5 Ica 3 Callao 2 Perú 29 Source: Based on the DHS 24-26 report, INEI. 6 Executive Summary

Infant and child mortality rates decreased from 43 and 59 per thousand live births in 1996 to 21 and 29 per thousand in 24-26, respectively. This reduction has been primarily due to improvements in health services for those living in rural areas, which has notably reduced the long standing gap in child health indicators between urban and rural areas. Figure 4 Infant Mortality Deaths occurring before the end of the first year of life, per thousand live births 8 6 4 Per thousand live births National Urban Rural 2 DHS 1996 DHS 2 DHS 24-26 Despite these positive changes in the reduction of infant and child mortality rates, there still remain health discrepancies. Examples such as the high prevalence of chronic child malnutrition, insufficient attendance in preschool education, the proportion of children lacking birth certificates, and the high incidence of family violence, among others, all continue to be challenges for the country. UNICEF/PERA-9146 Source: Based on the DHS 1996, DHS 2 and DHS 24-26 reports, INEI. The reports cover the 5 years preceding the survey. Situation of Children in Peru 7

Chronic malnutrition among children under five years has remained relatively constant at a rate of approximately 25% for the past 1 years. The current government aims to reduce this percentage by at least 9 points by 211. The seriousness of child malnutrition becomes evident upon observing regional differences, which shows that more than 3% of children between and 5 years in 9 different regions suffer from chronic malnutrition. Huancavelica is the most alarming case, where almost half of the children living in the region are reported to be undernourished. Figure 5 Chronic malnutrition and extreme poverty in children ages to 5 years 1 8 6 4 2 Huancavelica Chronic malnutrition Huánuco Ayacucho Lambayeque Junín Cusco Cajamarca Apurímac La Libertad Pasco Puno Ucayali Ancash Loreto Source: Based on ENAHO 26 (INEI) and the MONIN 24 report (INS-CENAN). Amazonas Piura San Martín Madre de Dios Moquegua Arequipa Lima Extreme poverty Ica Tumbes Tacna Huancavelica 49 88 Huánuco 41 65 Ayacucho 4 59 Junín 39 23 Lambayeque 39 18 Cusco 38 35 Cajamarca 36 42 Apurímac 33 62 La Libertad 32 35 Pasco 3 42 Puno 3 58 Ucayali 3 32 Ancash 26 31 Loreto 25 44 Piura 25 18 Amazonas 23 28 San Martín 21 26 Madre de Dios 21 6 Moquegua 2 6 Arequipa 17 6 Lima 16 4 Ica 13 3 Tumbes 12 1 Tacna 9 5 Perú 27 3 At the regional level, chronic malnutrition and poverty rates have a certain statistical relationship, but are not always necessarily correlated 3. In regions such as Lambayeque and Lima, there are more malnourished children between and 5 years than there are children who are living in extreme poverty 4. In other regions such as Huancavelica and Huánuco, however, there are children living in conditions of extreme poverty but who are not reported to be malnourished. Chronic malnutrition in Peru, therefore, appears to have other elements that condition it, as opposed to solely poverty rates. Nationally, 67% of children between the ages of 3 and 5 years are currently attending preschool, however this statistic falls to 56% for children living in rural areas. These figures become even lower when using the indicator of continuous attendance in preschool education (from the age of three years) 5, with 49% at the national level and only 36% for children living in rural areas. 3 The definition of extreme poverty used by the INEI is the inability to cover the cost of basic food needs for the family. Poverty refers to the household s inability to cover the cost of basic food needs and other life-essential items like health services, children s education, transportation, housing, footwear, and other items. 4 In figure 5, the regions that have more malnourished children than children living in extreme poverty are ones where the extreme poverty rate is below the chronic malnutrition rate. 5 The indicator for continued attendance in preschool education from the age of 3 years is used to determine effective insertion in early education and not solely for attendance at a given moment in time. 8 Executive Summary

There are significant differences at the regional and provincial levels, regarding children s right to identity and birth registration among children under 5 years of age. In the regions of Moquegua and Ancash, only 2% of children lack birth certificates, in contrast to Ucayali and Loreto where 27% and 26% do not have this document. The provinces with the greatest percentages of undocumented children are Atalaya (Ucayali) with 5% and Datem del Marañon (Loreto) with more than 6%. Figure 6 Provinces with the highest proportion of children lacking birth certificates Between 1 month and 5 years of age 7 6 5 4 3 2 1 Datem Del Marañón - Loreto Atalaya - Ucayali Carabaya - Puno Purus - Ucayali Loreto - Loreto Requena - Loreto Condorcanqui - Amazonas Puerto Inca - Huánuco Mariscal Ramón Castilla - Loreto Cajabamba - Cajamarca Ucayali - Loreto Coronel Portillo - Ucayali Oxapampa - Pasco Hualgayoc - Cajamarca Alto Amazonas - Loreto Maynas - Loreto Padre Abad - Ucayali Talara - Piura Pachitea - Huánuco San Marcos - Cajamarca Manu - Madre de Dios Tumbes - Tumbes Ferreñafe - Lambayeque Source: Based on the ENCO 26, INEI. In terms of domestic violence, 37% of mothers with children under five years old reported having suffered some kind of physical violence in the hands of their current or latest partner. As high as 11% of mothers with children under fiver years old reported having suffered physical aggression at least once during their pregnancy. Situation of Children in Peru 9

Childhood (6 to 11 years) UNICEF/PERA-9587 During childhood, the dimensions of education and protection of children s rights take on a greater relevance during development. It is a stage when the physical, intellectual, social and emotional capacities acquired in early childhood are consolidated. This does not mean that the aspects related to health and nutrition cease to be important, since a child needs adequate nutrition and health in order to be able to function in other areas. For example, several studies show that malnutrition and the deficit of micronutrients (iron, zinc, iodine and vitamin A) limit children s capacity to learn, generating difficulties in the use of language, memory, concentration and overall classroom participation. In other words, child malnutrition negatively affects children s school performance and abilities (CEPAL-UNICEF, 26). The main health problems of children in this age group are anaemia and malnutrition. At the national level, 32% of Peruvian children between the ages of 1 and 14 have anaemia, with significant differences at the regional and provincial levels. Pasco has the highest anaemia rate among children of this age, at 52%, followed by Puno at 49%, while San Martín and Lambayeque have lower anaemia rates of 12% and 14%, respectively. UNICEF/PERA-3531 1 Executive Summary

Map 2 The Child Development Index for children TUMBES LORETO PIURA Region CDI Tacna.88 Callao.88 Lima.87 Moquegua.86 Arequipa.84 Ica.82 Tumbes.81 Lambayeque.78 La Libertad.7 Junín.69 Madre de Dios.68 Piura.67 Ancash.67 Puno.67 San Martín.67 Cusco.63 Pasco.63 Amazonas.61 Ucayali.61 Loreto.6 Apurímac.6 Ayacucho.59 Group AMAZONAS LAMBAYEQUE CAJAMARCA 1 SAN MARTÍN LA LIBERTAD ANCASH UCAYALI HUÁNUCO PASCO 2 LIMA JUNÍN CALLAO MADRE DE DIOS 3 HUANCAVELICA ICA CUSCO APURÍMAC AYACUCHO PUNO 4 AREQUIPA MOQUEGUA 5 TACNA Cajamarca.56 Group 1: Greater or equal to.81 Huánuco.55 Group 2:.68 -.78 Huancavelica.46 Group 3:.67 -.67 Source: Based on ENCO 26, ENAHO 26 (INEI) and the Census of height among school children 25, Ministry of Education. Group 4:.61 -.63 Group 5: Lower or equal to.6 As in the case among the indicators included in the Child Development Index (CDI) for early childhood, Lima, Callao, Tumbes, Moquegua, Tacna Ica, and Arequipa, stand out as the regions with the best relative performance. Among the regions with the weakest relative performance, again we find Huancavelica, Huánuco, Cajamarca, Ayacucho, Apurímac and Loreto. The relative situation of the regions with regard to the development of children between the ages of 6 and 11 years is very similar to the development of children between the ages of and 5 years. However, these figures differ in terms of relative regional performance in the sense that the CDIs for children coincides more strongly with the ranking of the environment and protection of rights, while in early childhood it coincides more with the dimensions of learning and education. Situation of Children in Peru 11

Concerning chronic malnutrition among children between the ages of 6 and 9 years, Huancavelica is the region with the highest rate at 53%, which is more than double the national average of 22%. The region with the lowest rate of chronic malnutrition is Tacna, at only 4%. In the 1 provinces with the highest chronic malnutrition rates, values range from 52% to 62%, with the five provinces with the highest rates being Yarowilca (Huánuco) at 62%, Angaraes (Huancavelica) at 61%, Acobamba (Huancavelica) at 57%, and Cotabambas (Apurímac) and Condorcanqui (Amazonas) both at 56%. Figure 7 Chronic malnutrition rate in children between ages 6 and 9 years, at the provincial level 64 62 6 62 61 58 56 57 56 56 55 54 52 53 53 53 52 5 48 46 Yarowilca (Huánuco) Angaraes (Huancavelica) Acobamba (Huancavelica) Cotabambas (Apurímac) Condorcanqui (Amazonas) Churcampa (Huancavelica) Sánchez Carrión (La Libertad) Tayacaja (Huancavelica) Dos de Mayo (Huánuco) Huancabamba (Piura) Source: Census of height among school children 25, Ministry of Education. One of the areas with the most advancement in terms of Peruvian education has been primary school enrolment coverage. At the national level, 93% of all children between 6 and 11 years attend primary school. However, 4% still do not go to school, which is equivalent to approximately 145, children 6. With regard to over-age enrolment, 23% of Peruvian children between ages 6 and 11 years are enrolled in lower grades than the one corresponding to their age. This percentage is almost twice as high among children whose maternal language is Quechua (43%) and native Amazonian languages (45%). For children who live in situations of extreme poverty, this figure rises to 42%. 6 Of the 7% of children ages 6-11 years not enrolled in primary school, 3% attend education at another level and 4% do not attend school. 12 Executive Summary

In terms of school performance, 6% of sixth-grade primary school students are below the basic level for their corresponding grade in terms of communication skills, and 58% are below their grade in terms of mathematics. These figures vary greatly depending on regions: in Tacna 32% of students score below the basic level for their grade in math, as compared to 9% in Loreto. For communication skills, 38% of children living in Arequipa and Lima score below the basic reading comprehension level, as compared to 85% in Apurímac. Tacna, Moquegua, Lima, Callao and Arequipa are the regions with the best results in these areas, while children living in Apurímac, Cusco, Loreto, Ucayali and Ayacucho score the worst. The 4 regions with the greatest percentages of the population speaking native maternal languages are among the ones that have the lowest performance results. UNICEF/PERA-5133 Figure 8 Children in 6th grade of primary school grade with skills below the basic level for their corresponding grade COMMUNICATION SKILLS 1 8 6 4 2 Below one grade Lima Tacna Moquegua Arequipa Ica Callao Madre de Dios Below more than one grade Source: Based on the National Student Achievement Evaluation 24 UMC/MED. Below one grade or more La Libertad Lambayeque Tumbes Ancash Piura Junín Pasco Amazonas San Martín Huánuco Cajamarca Ucayali Huancavelica Puno Ayacucho Cusco Loreto Apurímac Lima 38 Tacna 4 Moquegua 39 Arequipa 38 Ica 52 Callao 43 Madre de Dios 55 La Libertad 57 Lambayeque 54 Tumbes 65 Ancash 61 Piura 61 Junín 62 Pasco 66 Amazonas 84 San Martín 73 Huánuco 75 Cajamarca 78 Ucayali 8 Huancavelica 81 Puno 77 Ayacucho 82 Cusco 82 Loreto 82 Apurímac 85 Perú 6 Situation of Children in Peru 13

With respect to child labour, at the national level in 26 around 2% of Peruvian children between 6 and 11 years work, a figure that rises to almost 4% in rural areas. While 8% of children from non-poor families study and work, the percentage is 4 times higher among children living in situations of extreme poverty (32%). Figure 9 Child labour by poverty level 1 8 6 55 Study and do not work 81 Study and work 91 With regard to water and sanitation services, the poorest regions tend to also be the ones with the lowest access to these services. In Loreto and Ucayali, 74% and 68% of children ages to 11 years currently lack access to improved drinking water sources, Source: Based on the ENAHO 26, by INEI. Reports for April through December. respectively. 86% and 8% of children under 11 years in Huancavelica and Ucayali lack access to improved sanitation facilities. In contrast, in Tacna and Moquegua, only 8% and 9% lack access to improved water sources, and in Lima and Callao only 18% and 15% of children have no access to improved sanitation sources. 4 2 32 Extremely poor Poor Non-poor 16 8 14 Figure 1 Children between and 11 years lacking access to improved sources of water or sanitation 1 8 6 4 2 Loreto Have no access to improved sources of water or sanitation Source: Based on ENCO 26, INEI. Executive Summary Have no improved water source Have no improved sanitation sources Ucayali Pasco Huánuco Huancavelica Cajamarca Amazonas Puno Piura San Martín Madre de Dios Junín Cusco Apurímac La Libertad Ayacucho Tumbes Lambayeque Ancash Arequipa Ica Callao Lima Moquegua Tacna Loreto 67 74 77 Ucayali 61 68 8 Pasco 54 65 68 Huánuco 52 57 71 Huancavelica 51 53 86 Cajamarca 49 53 77 Amazonas 48 55 71 Puno 48 5 69 Piura 38 41 65 San Martín 37 45 63 Madre de Dios 34 36 72 Junín 32 36 53 Cusco 32 36 57 Apurímac 3 34 68 La Libertad 28 32 52 Ayacucho 28 35 57 Tumbes 24 36 42 Lambayeque 23 32 36 Ancash 22 24 57 Arequipa 14 16 36 Ica 14 17 4 Callao 12 21 15 Lima 12 18 18 Moquegua 7 9 31 Tacna 7 8 22

Adolescents (from 12 to 17 years) UNICEF/PERA/26/Ouvrard The period of adolescence is one of life s most complex transitions, surpassed only by early childhood considering rapid rates of growth and change. During this stage, adolescents define their personality, establish their emotional and psychological independence, learn to understand and experience their sexuality, and reflect on their role in society. The physical and emotional changes that take place in this period consolidate and often define the characteristics the adolescent will face during adulthood (UNICEF, 22). In Peru anaemia is a serious problem among adolescents as well as for younger generations. At the national level, anaemia affects 32% of young people ages 1 to 14 years, 35% ages 15 to 19 years and 39% of adolescents living in the rural area. The differences in the prevalence of anaemia among adolescents become more evident when we compare individual regions. San Martín is the region with the lowest rate of adolescents with anemia (2%), which is less than half the prevalence rate of anemia among adolescents who live in Pasco and Puno (5%). Figure 11 Anaemia in adolescents between ages 15 and 19 years 6 45 3 15 Pasco Source: Based on MONIN 24, CENAN. Puno Huánuco Ucayali Junín Moquegua Lima Cajamarca Ancash Apurímac La Libertad Tacna Loreto Arequipa Amazonas Huancavelica Cusco Ica Piura Ayacucho Lambayeque Tumbes Madre de Dios San Martín Pasco 5 Puno 5 Huánuco 48 Ucayali 44 Junín 43 Moquegua 4 Lima 39 Cajamarca 35 Ancash 33 Apurímac 33 La Libertad 31 Tacna 31 Loreto 3 Arequipa 29 Amazonas 26 Huancavelica 26 Cusco 25 Ica 24 Piura 24 Ayacucho 24 Lambayeque 23 Tumbes 22 Madre de Dios 21 San Martín 2 Perú 35 Situation of Children in Peru 15

Map 3 The Child Development Index for adolescents TUMBES LORETO PIURA Region CDI Tacna.75 Group Arequipa.74 Tumbes.74 Ica.72 Moquegua.71 Lambayeque.7 Lima.7 Madre de Dios.69 Callao.67 Piura.64 Junín.64 LIMA La Libertad.64 CALLAO Cusco.6 San Martín.59 Ancash.59 Ucayali.59 Apurímac.58 Pasco.58 Amazonas.57 Puno.57 Ayacucho.52 Loreto.52 Huancavelica.52 Cajamarca.51 Group 2:.67 -.71 Huánuco.48 Group 3:.59 -.64 AMAZONAS LAMBAYEQUE 1 CAJAMARCA SAN MARTÍN LA LIBERTAD 2 ANCASH UCAYALI HUÁNUCO PASCO JUNÍN MADRE DE DIOS 3 HUANCAVELICA ICA CUSCO APURÍMAC AYACUCHO PUNO 4 AREQUIPA MOQUEGUA 5 Source: Based on ENCO 26, ENAHO 26 (INEI) and MONIN 24 (CENAN). TACNA Group 1: Greater or equal to.72 Group 4:.57 -.58 Group 5: Lower or equal to.52 Regions where the Child Development Index (CDI) for adolescents reflects the weakest performance are Huánuco, Cajamarca, Huancavelica, Loreto and Ayacucho. On the other hand, the ones with the best performance are Tacna, Arequipa, Tumbes and Ica. The ranking of the CDI for adolescents is quite similar to the ranking of indicators in the educational dimension, and less similar to that of health and nutrition indicators. This fact contrasts with the children s CDI, where the overall index ranking is more similar to the rankings of the environment and protection of rights. 16 Executive Summary

There is a high incidence of young people in Peru between the ages of 2 and 29 years with HIV/AIDS. Once the HIV virus is transmitted, several years can pass before it is manifested as AIDS, so a significant proportion of these youths may have contracted the virus during adolescence. In this context, it is important to note that according to the DHS 24-26, 25% of young women between 15-19 years only know that HIV/AIDS exists, but are unaware of how to prevent infection. Almost 1% of this same population say they have never heard of HIV/AIDS. The enrolment rate of students in secondary education is significantly lower than that of primary school: 73% of adolescents between the ages of 12 and 17 years are enrolled in secondary education. Of the other 27%, 14% are in primary school and 13% are not attending school. Again, wide gaps in secondary school attendance can be observed based on poverty levels and maternal language. While 84% of non-poor students are enrolled in secondary school, the attendance rate among students who live in households of extreme poverty is only 49%. 76% of adolescents with Spanish as their maternal language are enrolled in secondary level, versus 43% of students whose maternal languages are Amazonian. These figures represent a challenge to increase secondary education opportunities at the levels of infrastructure, equipment and teacher training, especially for those students living in rural areas. Net secondary coverage of adolescents between 12 and 16 years 1/ Percentage of adolescents enrolled in secondary with respect to the total adolescent population Secondary school enrolment Poverty level Extremely poor 49 Poor 7 Non-poor 84 Total 73 Maternal language Spanish 76 Quechua 57 Aymara 72 * Other native languages 43 * Total 73 Source: Based on the INEI s ENAHO 26. Reports for April through December. 1/ Asterisks indicate imprecise indicators. * This indicator should be used with caution. Its relative standard error (RSE) is greater than 1% and less than 3%. UNICEF/PERA-329 Situation of Children in Peru 17

Only 57% of all adolescents in Peru between the ages of 17 and 19 years have finished secondary education. While 62% of adolescents between the ages of 17 and 19 years with Spanish as their maternal language have finished secondary education, only 25% of adolescents whose maternal language is Quechua have finished. In terms of poverty rates, 71% of nonpoor adolescents have finished secondary education, as compared to 48% of young people living in poor households and 22% living in households of extreme poverty. Adolescents 17 to 19 years of age and youths between 2 and 21 years that have finished secondary education 1/ Adolescents 17 to 19 years Young people 2 to 21 years who completed secondary school who completed secondary school Area of residence Urban 7 82 Rural 33 49 National 57 72 Poverty level Extremely poor 22 35 * Poor 48 61 Non-poor 71 85 Total 57 72 Maternal language Spanish 62 75 Quechua 25 * 52 Aymara 62 * 84 Other native languages 22 * 32 * Total 57 72 Gender Women 59 73 Men 56 72 Total 57 72 Source: Based on the INEI s ENAHO 26. 1/ Asterisks indicate imprecise indicators. * This indicator should be used with caution. Its relative standard error (RSE) is greater than 1% and less than 3%. Mathematics test results of students in 11th grade are homogeneously not at the level they should be, with the percentage of students with tests results below the basic level ranging from 71% (Tacna) and 97% (Uycali and Puno). The low learning achievement is observed more seriously during secondary school. In Tacna and Moquegua, 32% and 33% of the students in the 6th grade, respectively, scored below what is considered basic level in mathematics. These figures increase to 71% and 83%, respectively, for students attending the 11th grade. Among regions with more than 5% of their students below the basic level for communication skills, ranked Puno (78%), Huancavelica (73%), Apurímac (63%), Cuzco (56%) and Ayacucho (52%). These are the same regions that have the highest percentages of adolescents who speak maternal languages other than Spanish. In the case of Huancavelica and Ayacucho, they also have greater problems with over-age enrolment. 18 Executive Summary

Figure 12 Adolescents in the 11th grade with skills below the basic level for their corresponding grade MATHEMATICS 1 8 6 4 2 Tacna Callao Below one grade Below more than one grade Moquegua Arequipa Junín Madre de Dios Lima La Libertad Pasco Lambayeque Cusco Ayacucho Piura Tumbes Amazonas Ancash Huánuco Cajamarca Apurímac Ica Huancavelica Source: Based on the National Student Achievement Evaluation 24 UMC/MED. Below one grade or more San Martín Loreto Puno Ucayali Tacna 71 Callao 8 Moquegua 83 Arequipa 79 Junín 8 Madre de Dios 92 Lima 82 La Libertad 86 Pasco 82 Lambayeque 87 Cusco 88 Ayacucho 87 Piura 88 Tumbes 9 Amazonas 93 Ancash 9 Huánuco 89 Cajamarca 91 Apurímac 94 Ica 93 Huancavelica 93 San Martín 97 Loreto 95 Puno 97 Ucayali 97 Perú 86 Figure 13 Children and adolescents between ages 6 and 17 years who are enrolled in grades that do not correspond to their age by work situation 1/ Work and are enrolled in grades that do not correspond to their age Do not work and are enrolled in grades that do not correspond to their age 1 8 6 4 2 San Martín Loreto Lambayeque Ayacucho Cajamarca Ucayali Ancash Callao La Libertad Huancavelica Huánuco Piura Tumbes Amazonas Apurímac Source: Based on ENAHO 26, INEI. Reports April through December. 1/ Over-age enrolment is defined as the ratio of students matriculated into a lower grade than expected for their age. In the case of a 17-year-old adolescents, this would mean not having completed secondary education. Work is defined based on module 2 of the ENAHO 26 (in contrast to the data utilized for the analysis of work among adolescents between 14 and 17, in tables 44, 45a and 45b, which was possible to perform with detailed information from the employment module). For more information on the comparability of these reports, see Rodríguez and Vargas (26). Ica Cusco Pasco Puno Junín Lima Madre de Dios Arequipa Tacna Moquegua Situation of Children in Peru 19

In Peru, 5% of adolescents between the ages 14 and 17 years work, a figure more than double the rate for children between the ages 6 and 11 years. Among adolescents that work there are significant differences based on residence: in urban areas 32% of adolescents work, compared with 8% who live in rural areas. In almost all regions, over-age enrolment for children between 6 and 17 years is greater for those who work than for children who only study. San Martín is the region with the greatest difference in the percentage of over-age enrolment between those who both work and study (82%) and those that only study (39%). With regard to pregnancy among adolescents, 13% of Peruvian females between the ages of 15 and 2 years have given birth to at least one child a figure that in regions like Loreto and Ucayali increases to 27% and 25%, respectively. Adolescent pregnancy is more common among women between the ages 15 of 2 years with native Amazonian maternal languages like Shipibo-Conibo, Aguaruna and Asháninka, as compared to adolescent women with Quechua, Aymara or Spanish as their maternal languages. Figure 14 Adolescent mothers between ages 15 and 2 years, by maternal language 1/ (of the total number of adolescent who share the same maternal language) 5 4 3 2 1 Shipibo Conibo (.1%) Aguaruna (.2%) Asháninka (.3%) Other native languages (.4%) Aymara (1.2%) Quechua (11%) Spanish (86.6%) Source: Based on ENCO 26, INEI. 1/ Under each linguistic group is listed that group s percentage amongst the total national population. 2 Executive Summary

(*) Relative standar error (EER) between 1% and less than 3%. The percentages associated with these should be read with caution if the number of cases impedes to compare between groups with close percentages. In other words, two different percentages that are very close, however they can be statistically equal. (**) Relative standar error (EER) equal or greater than 3%. The percentages associated with these cells present confidence levels that are not acceptable. 1/ Based on ENAHO 26, INEI. 2/ Based on ENCO 26, INEI. 3/ Taken from Final Report MONIN 24 of CENAN. "n.d." signifies data not available.