World Development Vol. 31, No. 1, pp.

23–52, 2003
Ó 2002 Elsevier Science Ltd. All rights reserved
Printed in Great Britain
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PII: S0305-750X(02)00121-3

Progress Toward the Millennium Development

Goals in Africa
DAVID E. SAHN and DAVID C. STIFEL *
Cornell University, Ithaca, NY, USA
Summary. — We analyze demographic and health surveys to examine the progress of African
countries in achieving six of the seven millennium development goals (MDG) set forth by the
United Nations. Our results paint a discouraging picture. Despite some noteworthy progress, the
evidence suggests that, in the absence of dramatic changes in the rates of improvement in most
measures of living standards, the MDG will not be reached for most indicators in most countries.
The results are particularly sobering for rural areas, where living standards are universally lower,
and where rates of progress lag behind urban areas.
Ó 2002 Elsevier Science Ltd. All rights reserved.

Key words — Africa, development goals, poverty, welfare measures, urban–rural

1. INTRODUCTION eliminating the gender gap in enrollments in

The United Nations (UN) recently articu-
lated a series of ambitious goals toward the
reduction of poverty. The millennium develop-
ment goals (MDG) originated from a series of
UN resolutions and agreements made at world
conferences held over the past decade, and were
put forward with the recognition that while
substantial improvements in living conditions
have occurred in many countries, performances
have been uneven and painfully slow in much of
the developing world (UN, 2000; IMF, OCED,
UN & World Bank, 2000). The problem of
faltering social progress is especially acute in
Africa, in contract to other regions that have
witnessed more sustained improvements in
living standards (UNICEF, 2000). Further-
more, in light of the weak and often faltering
macroeconomic performances in much of sub-
Saharan Africa, the prospects of continued civil
conflict and vulnerability to negative shocks
due to weather and related natural events, and
the fact that fertility rates and population
growth outpace other regions, realizing the
MDG in the years ahead will be a particularly
challenging task in sub-Saharan Africa.
Six of the seven MDG are set in clear
quantitative terms. They include: (a) reducing
the proportion of people living in extreme
poverty by half during 1990–2015; (b) ensuring
that all children are enrolled in primary school
by 2015; (c) reducing gender inequality through
23
both primary and secondary school by 2005;
(d) reducing infant and child mortality by two-
thirds during 1990–2015; (e) reducing maternal
mortality ratios by three-quarters during 1990–
2015; and (f) ensuring that all women have
access to reproductive health services by 2015.
The seventh goal involves strategies to reverse
loss of environmental resources through im-
plementing sustainable development strategies.
While there is some evidence on the perfor-
mance of regions toward realizing these goals,
the empirical evidence on how well particular
countries are performing relative to these goals
remains sparse. Where information does exist,
it is often not based on the type of detailed
empirical analysis of survey data needed to get
an accurate portrayal of progress. 1 In this
paper, we analyze a set of reliable household
survey data to examine the progress of African
countries toward achieving the MDG. We are
* The authors would like to express their gratitude to
the African Development Bank, the United States
Agency for International Development, and the World
Bank for funding this work. They would also like to
thank two anonymous referees for their insightful com-
ments, and Aparna Lhila for her skilled research assis-
tance. Finally, we are indebted to Macro International
Inc., for supplying the data, and in particular, Bridget
James for her assistance and prompt responses to que-
ries. Final revision accepted: 11 July 2002.
24 WORLD DEVELOPMENT
motivated by the need (i) to provide sound
empirical estimates of how well African coun-
tries are doing in general, and (ii) to assess the
prospects of these countries toward realizing
the MDG. The latter is done by extrapolating
past progress, and comparing these projections
to the rates of change that are necessary to re-
alize the MDG. Throughout our analysis, we
disaggregate between rural and urban areas.
We find that doing so is particularly important
given the substantial evidence of far worse
poverty, and significantly lower living stan-
dards in rural than in urban areas in Africa.
Therefore, we are particularly interested in
comparing the levels and progress toward the
MDG in rural areas to those in urban areas. 2
A new generation of nationally representa-
tive household income and expenditure surveys
has helped to provide a better understanding of
living standards in Africa. Prominent among
these surveys is the so-called living standards
measurement surveys (LSMS), which have been
implemented and funded by the World Bank. 3
These surveys have been enormously useful for
the analysis of the level and characteristics of
poverty in many African countries. In addition,
there has been a series of recent studies that
carefully examine changes in poverty based on
household income and expenditure surveys. 4
While many of these studies have attempted
to address issues such as variable recall periods
(Scott & Amenuvegbe, 1990), differences in
commodity lists (Pradhan, 2000), and the well-
know difficulty of defining accurate deflators
for intertemporal and spatial comparisons, they
are still limited in as far they do not involve
reliable cross-country comparisons of well-be-
ing, 5 and do not address the broader issue of
living standards defined over a vector of pos-
sible indicators of well-being. Thus, while we
have learned a great deal about poverty, the
demographic and health surveys (DHS) pro-
vide us an opportunity to inform the question
of how living standards across a wide-range of
nonmoney metric indicators are evolving in
Africa across a variety of dimensions. Not only
have the DHS been collected in a large number
of African countries, in many cases, at more
than one point in time, 6 but the survey in-
struments are standardized for all countries,
and the procedures for sampling and data col-
lection do not vary substantially over time.
Therefore, we can confidently compare living
standards across time periods, within a given
country, and also across countries for many of
our poverty measures.
In the remainder of the paper we begin with a
more detailed discussion of the methods we
employ, and the variables we construct and use
to evaluate progress corresponding to the six
quantifiable MDG. We add a seventh goal on
child nutritional status––reducing malnutrition
by two-thirds––because we feel it is of great
importance, and that its absence was conspic-
uous in the UN deliberations. In addition, we
discuss the methods for making projections
based on the data we have available on past
performance. Section 3 then provides more
details about the data, including when and
where they were collected. This is followed by a
discussion of the results in Section 4. We con-
clude with some observations about the use-
fulness of the goals, and our attempt to
measure progress and prospects for future
progress.
2. METHODS
In this section we describe the indicators and
methods that we use to evaluate the progress of
African countries with DHS data toward
achieving the MDG. We do so by addressing
each goal separately.
(a) The goals
Goal 1: Reduce the proportion of people living in ex-
treme poverty by half between 1990 and 2015
Given the absence of income and/or expen-
diture data in the DHS data, we employ factor
analysis to construct an alternative measure of
economic well-being––an asset index––to track
poverty over time within each country. 7 The
assets included in this index can be placed into
three categories: household durables, house-
hold characteristics and human capital. The
household durables consist of indicators of
ownership of radios, stereos, TVs, sewing ma-
chines, stoves, refrigerators, bicycles, and mo-
torized transportation (motorcycle and/or
cars). The household characteristics include
indicator variables for sources of drinking
water (piped or surface water relative to well
water), toilet facilities (flush or no facilities
relative to pit or latrine facilities), cooking fuel
(gas or electricity), and household construction
material (indicators for quality of floors). We
also include the years of education of the
household head to account for householdÕs
stock of human capital.
 MILLENNIUM DEVELOPMENT GOALS IN AFRICA
One of the properties of the asset index is
that its distribution has zero mean and unit
variance. Since we want to compare the dis-
tributions of assets over survey years for each
country, the datasets for each of the 11 coun-
tries for which we have at least two years of
survey data (and estimates of $1/day poverty
rates––more on this below), are pooled by
country and the factor analysis asset weights
are estimated for each pooled sample. They are
then applied to the separate samples to esti-
mate the asset indices for each of the house-
holds in those samples. 8 To calibrate initial
poverty levels, we estimate poverty lines for
each of the 11 countries endogenously in order
to replicate the national $/day poverty rates
found in the World Development Indicators
(World Bank, 2001a, b). 9 Because the DHS
survey years and those years for which we
have $/day poverty estimates coincide for only
Ghana and Madagascar, the poverty lines
must be estimated iteratively for all of the
other countries by assuming a linear rate of
change in poverty between the two survey
years. 10 Once we have the poverty lines for
each country, urban and rural poverty rates
are estimated for 1990 and for the last survey
year. We further project linear and log-linear
poverty rate paths to the year 2015 based on
‘‘observed’’ changes in poverty. These are
compared to linear target paths based on the
stated MDG, which in the case of poverty is
to cut the percentage living in extreme poverty
by one half.
Goal 2: Enroll all children in primary school by 2015
For 10 African countries, the household
roster section of the DHS data records age of
individuals and their educational status for at
least two survey periods. 11 Using this infor-
mation, we estimate the percentage of children
between the ages of six and 14 inclusive in
urban and rural areas who were enrolled in
school at the time of the survey. In a manner
similar to the poverty estimates, we predict
urban and rural enrollments in 1990 assuming a
linear change in enrollment between the survey
periods. Both linear and nonlinear enrollment
paths to the year 2015 are predicted and com-
pared to the target path leading to the MDG
of 100% enrollment in 2015.
Goal 3: Make progress toward gender equality and
empowering women by eliminating gender disparities
in primary and secondary education by 2005
25
For the same 10 countries for which we es-
timate changes in enrollments, we also estimate
changes in the ratios of girls-to-boys enrolled in
primary and secondary schools. This indicator
of gender disparity in education is calculated by
simply estimating in the samples of all indi-
viduals enrolled in primary and secondary
schools, the ratio of girls to boys regardless of
their age. These ratios (multiplied by 100) are
predicted in urban and rural areas in 1990 as-
suming a linear change in the ratios between the
survey periods. Both linear and nonlinear ratio
paths to the year 2005 are predicted and com-
pared to the target path leading to the MDG of
100 in 2005.
Goal 4: Reduce infant and child mortality rates by
two-thirds between 1990 and 2015
Infant mortality rates (IMR) are constructed
from the section of the individual survey in-
strument that includes birth histories of each of
the women interviewed. This provides infor-
mation on all live births, the ages of living
children, and the dates of deaths of children
who did not survive to the date of interview.
Infant mortality (1 q0 ) for a given cohort of
children is defined as the simple probability of a
child dying before his/her first birthday. The
retrospective nature of the birth histories,
however, gives rise to a censoring problem in
the estimation of mortality rates. Since the
birth histories are recorded for women of child-
bearing age (15–49) at the time of the interview,
observations on births 10 years prior to the
interview do not account for children born to
the cohort of women age 40–49 at that time.
Sahn, Stifel, and Younger (1999) find statisti-
cally significant parameters across-the-board
for 10 countries on the age and age squared of
the mother in infant mortality regressions.
Thus, uncorrected estimates of IMR become
more biased as one goes back in time from the
date of the survey, and are not comparable
across surveys for a given time period. To avoid
the censoring problem, we truncated the sample
of children to only those born to mothers of age
15–39 at the date of birth, or roughly 90% of all
children reported to have been born in each of
the samples, and we extend our mortality esti-
mates back only 10 years from the date of the
survey.
IMR are estimated for cohorts of children
born in each of the 10 years prior to the date of
the survey for the 24 African countries with
DHS data. 12 Note that we exclude from our
26 WORLD DEVELOPMENT
sample all children born within one year of the
survey because these observations represent
censored spells (i.e., the child may still have
died before his/her first birthday though after
the enumerators visited the household). 13 Re-
gression lines are then estimated through these
data points to estimate linear annual rates of
change in IMR. We allow these rates of change
to differ across survey years and report them as
such when they are statistically different. When
they do differ statistically, we use the estimated
rates of change for the last survey to predict
mortality rates in 1990 and in 2015. Otherwise
we use the pooled estimates to predict both
linear and nonlinear IMR paths from 1990 to
the year 2015 and compare them to the target
path leading to the MDG of one-third of the
mortality rate in 1990.
Goal 5: Reduce maternal mortality ratios by three-
quarters between 1990 and 2015
Because of the difficulty in measuring actual
maternal deaths (i.e., deaths at childbirth), we
employ a proxy for the prevention of such
deaths. Given that a large number of maternal
deaths follow from infections, blood loss and
unsafe abortion, and are thus preventable, the
proportion of births attended by skilled health
personnel provides a means of tracking pro-
gress in preventing them. Further, since this
form of health care is a primary policy mech-
anism that can be employed to address mater-
nal mortality, tracking it allows us to also track
the progress of public policy toward achieving
this goal. Thus, while we are unable to measure
the output (maternal deaths) we can and do
measure changes in an input into reducing
maternal mortality (births attended by skilled
health personnel).
This indicator of the quality of neonatal care
is recorded in the maternity section of the in-
dividual survey instrument in the DHS. In this
section, all women are asked about births
within the five years prior to the survey, in-
cluding who was present at the birth. If a
doctor, a nurse, a midwife and/or a ‘‘trained
health professional’’ was present at a birth,
then the mother is recorded to have received
neonatal health care from skilled health per-
sonnel for that particular birth. Since there are
many mothers in the samples with more than
one birth recorded in the five years prior to the
surveys, it is possible (and observed) for some
women to have births that were both attended
and not attended by trained professionals. The
percentage of births attended by skilled per-
sonnel are estimated for cohorts of children
born in each of the five years prior to the date
of the survey for the 24 countries with DHS
data. 14 Regression lines are then estimated
through these data points to estimate linear
annual rates of change, and to predict the
percentage of births attended by skilled health
personnel in 1990 and 2015. Both linear and
nonlinear paths from 1990 and 2015 are pre-
dicted and compared to the target path leading
to a proxy for the MDG of reducing maternal
mortality by three quarters (i.e., 90% of births
attended by skilled health personnel).
Goal 6: Provide access for all who need reproductive
health services by 2015
The DHS data have a wealth of information
on knowledge and use of contraceptives. Each
woman in the individual survey instrument is
asked detailed questions about contraceptives
as well as her current reproductive status. This
permits us to estimate the share of women in
need of reproductive health services who have
knowledge of modern contraceptives and who
use them. Two issues need clarification here.
First, we define women who need access to
modern contraceptives as those who are fecund
and do not currently want to get pregnant. To
do this, we drop from our sample of women
those who are declared infecund or are meno-
pausal, and those who report desiring to have
children. This leaves nonmenopausal women
who either want no more children or report
wanting a child but after two or more years
(i.e., desiring to space the births). Second,
modern contraceptives are defined as the pill,
IUD, injections, diaphragm, foam, jelly, con-
dom, sterilization (male or female), Norplante
or other implants.
The percentage of women in need of access to
reproduction health services who know of, and
use modern contraceptive methods are esti-
mated for urban and rural areas in the 13 Af-
rican countries with at least two DHS surveys.
These percentages are predicted for 1990 as-
suming a linear change in the ratios between the
survey periods. Both linear and nonlinear per-
centage paths to the year 2015 are predicted
and compared to the target path leading to the
MDG of 100% in 2015.
Additional goal: Reduce child malnutrition by two-
thirds during 1990–2015
 MILLENNIUM DEVELOPMENT GOALS IN AFRICA
The indicator of nutritional status used in
this paper (and available in the DHS) is the
height-for-age of children less than five years of
age standardized to a healthy reference popu-
lation. This height-for-age z-score (HAZ) is an
indicator of a childÕs long-term nutritional
status. 15 Children who are ‘‘stunted’’ are those
whose past chronic nutritional deprivations
leave them shorter than expected for their age
and gender cohorts in the reference population.
In keeping with convention (WHO, 1983),
chronic malnutrition is defined as the percent-
age of the sample of children with HAZ scores
below
2 (i.e., stunting rates). 16
Stunting rates are estimated in urban and
rural areas in the 14 countries that have at least
two DHS surveys with anthropometry sections.
Both linear and nonlinear malnutrition paths
from the last survey year for each country to
the year 2015 are predicted and compared to
the target path leading to a reduction in stun-
ting rates by two-thirds.
(b) Determination of progress
The above discussion details how we go
about defining and measuring the various in-
dicators in the MDG and sketches out how we
compare progress to the goals themselves. But
in addition to comparing extrapolated progress
to the goals, we address the question of whether
there has been any progress in the various in-
dicators that comprise the MDG, regardless of
the question of whether the progress is consis-
tent with the targets themselves. To do so, we
conduct various statistical tests of changes over
time. These are perhaps of greater importance
since the goals themselves are in essence polit-
ical statements, and failure to achieve the goals
is not synonymous with failure to achieve social
progress.
In terms of the mechanics of our statistical
comparisons of progress in the various indica-
tors, we employ standard statistical tests using
t-statistics for all of the goals (with the excep-
tion of infant mortality and neonatal care,
where we base our tests on the statistical sig-
nificance of the slope parameters estimated
from our regression models). In addition, for
our poverty and nutrition indicators that are
derived from distributions with arbitrary cutoff
points used to distinguish the poor (malnour-
ished) from the nonpoor (well-nourished), we
employ standard tests of welfare dominance to
compare the distributions of our nutritional
27
status indicators and asset index over time. The
idea is to make ordinal judgments on how
poverty changes for a wide class of poverty
measures over a range of poverty lines (Da-
vidson & Duclos, 2000; Ravallion, 1996). We
discuss the concept of welfare dominance, and
explain how we estimate the orderings and
perform statistical inference on them in the
appendix.
3. DATA
The DHS program has conducted over 70
nationally representative household surveys in
more than 50 countries since 1984. With fund-
ing from USAID, the program is implemented
by Macro International, Inc. In this study, we
use 43 of the surveys for 24 sub-Saharan Afri-
can countries that have cross-sectional surveys
available. The DHS surveys are conducted in
single rounds with two main survey instru-
ments: a household schedule and an individual
questionnaire for women of reproductive age
(15–49). The household schedule collects a list
of household members and basic household
demographic information and is used primarily
to select respondents eligible for the individual
survey, though in later waves of the survey,
information was also collected on educational
status and attainment of all household mem-
bers. The individual survey, inter alia, provides
information on household assets, reproductive
histories, health, and the nutritional status of
the womenÕs young children. The quality of the
data is generally good with improvements made
over successive rounds.
In the first wave of DHS surveys (DHS I),
co-resident husbands of women successfully
interviewed in the individual survey were gen-
erally also interviewed in half of the clusters.
This practice was changed in the later waves
(DHS II and III) to have a nationally repre-
sentative sample of men, by interviewing all
men aged 15–49 living in every third or fourth
household.
Although the designs of the surveys are not
entirely uniform over time and across coun-
tries, efforts were made to standardize them, so
that in most cases they are reasonably compa-
rable. 17 The DHS program is designed for
typical self-weighted national samples of 5,000–
6,000 women between the ages of 15 and 49. In
some cases the sample sizes are considerably
larger, and some areas are over- or undersam-
pled. Household sampling weights are used to
28 WORLD DEVELOPMENT
account for over- and undersampling in various
regions within surveys. Since all regions are sam-
pled in the DHS surveys, with the exception of
Uganda, we make the surveys nationally repre-
sentative through the use of sampling weights.
Districts in northern Uganda were not included
in the 1988 survey because of armed conflict.
Table 1 shows the 24 African countries with
DHS data and the years in which the data were
collected. It also shows which indicators are
available for each country. For example, all of
the indicators are available for Burkina Faso,
Ghana, Kenya, Madagascar, Niger, Nigeria,
Tanzania, Zambia and Zimbabwe. Cameroon
has all of the indicators except asset poverty
because there are no estimates for $/day pov-
erty for this country available in the 2001
World Development Indicators, and as such an
absolute percentage of the population living in
extreme poverty cannot be estimated using the
asset index. Further, Mali has all of the indi-
cators except those concerned with enrollments.
This follows because the 1987 data were col-
lected in the first wave in which no information
was recorded on the education of the household
members. 18 For the nine countries with only
one survey, indicators are only available for
changes in infant mortality and neonatal care.
4. RESULTS
In this section we present the results of our
analysis of progress toward the MDG in Af-
rica. We do so by indicating whether countries
are on track to realize the goals and if im-
provements in the various welfare measures
have been observed in general during the time
periods for which data were available. In other
words, we compare linear target paths which
illustrate the changes required per year to re-
alize the MDG, with both linear and nonlinear
projections of changes over the span of time
relevant to the particular MDG in question.
While we have little basis for assuming that
past performance is a good predictor of what
will happen in the future, or that either log-
linear or linear projections will reflect the evo-
lution of the indicators that we examine, the
projections are benchmarks which give a sense
of where countries will be relative to the MDG
if the various rates of change in the relevant
indicators continue as they have to date.
Before examining changes in poverty over
time and how these changes fare relative to the
goal of halving the percentage of those who live
in extreme poverty, we first inspect the starting
levels of poverty (represented by the value
measured at the initial survey) in urban and
rural areas. Note that in Table 2, poverty rates
in each country are substantially higher in rural
than urban areas, and in many cases this is
difference is dramatic (e.g., Burkina Faso and
Zimbabwe). This finding is consistent with
findings reported elsewhere based on the use of
more traditional expenditure type metrics of
poverty incidence (Sahn, Dorosh, & Younger,
1997).
The results on changes in rural poverty in-
dicate that only in the cases of Ghana and
Madagascar, do poverty rates decline at a pace
that is greater than or equal to the linear trend
required to realize the MDG. Having said this,
for the rural areas in these two countries, if we
assume diminishing gains in our projections
(i.e., the log-linear projections), the target is
unlikely to be reached. In other countries,
particularly Mali, Nigeria and Tanzania, we
find substantial declines in rural poverty, but
given the high initial levels, the paces of change
are not commensurate with linear projections
to realize the goal. Nonetheless, as in Ghana
and Madagascar, these findings of declining
poverty for Mali and Nigeria are insensitive to
the choice of the poverty measure or the pov-
erty line (i.e., there is statistically significant
first-order dominance––see the appendix for
details). 19 Kenya and Tanzania also witnessed
statistically significant declines in the levels of
rural poverty. In both these cases, however, the
results are sensitive to the choice of poverty line
and poverty measure employed (i.e., we cannot
reject the null hypothesis of nondominance). It
is also worth noting that in Zambia and in
Zimbabwe, statistical comparisons indicate
worsening rural poverty. In the case of Zim-
babwe, we find first-order dominance. Whereas
in Zambia, we find statistically significant sec-
ond-order improvement. In other words, when
we measure poverty using the headcount ratio,
we find an increase in rural poverty (at the $/
day poverty line). But when we use more dis-
tributionally sensitive measures of poverty (e.g.,
poverty gap index or the poverty severity index)
or lower poverty lines, we find that rural pov-
erty actually fell. This follows because, while
the percentage of rural households in poverty
rose, the well-being of the poorest households
improved.
In urban areas, on the other hand, poverty
rates in Ghana, Kenya, Mali, Niger, Senegal
and Tanzania are decreasing at paces greater
 Table 1. International Development Goals (IDG) and the DHS
Goals Goal 1 Goal 2 Goal 3 Goal 4 Goal 5 Goal 6 Extra
Halve Enrol all Gender equality in Reduce Reduce maternal mortal- Access to reproductive Reduce malnutri-
poverty children schools IMR by 2=3 ity by 3=4 health services tion by 2=3

Indicator Asset Enroll- Ratio of girls-to- IMR Neonatal care with skilled Contraceptive knowledge Stunting

MILLENNIUM DEVELOPMENT GOALS IN AFRICA

poverty ments boys enrolled personnel and use
Countries
1 Benin (1996) X X
2 Burkina Faso (1992, 1999) X X X X X X X
3 Burundi (1987) X X
4 Cameroon (1991, 1998) X X X X X X
5 Central African Republic (1994) X X
6 Chad (1997) X X
7 Comoros (1996) X X
8 C^
ote dÕIvoire (1994) X X
9 Ghana (1988, 1993, 1998) X X X X X X X
10 Kenya (1988, 1993, 1998) X X X X X X X
11 Madagascar (1992, 1997) X X X X X X X
12 Malawi (1992) X X
13 Mali (1987, 1995) X X X X X
14 Mozambique (1997) X X
15 Namibia (1992) X X
16 Niger (1992, 1997) X X X X X X X
17 Nigeria (1990, 1999) X X X X X X X
18 Rwanda (1992) X X
19 Senegal (1986, 1992, 1997) X X X X X
20 Tanzania (1991, 1996, 1999) X X X X X X X
21 Togo (1988, 1998) X X X
22 Uganda (1988, 1995) X X X X
23 Zambia (1992, 1996) X X X X X X X
24 Zimbabwe (1988, 1994, 1999) X X X X X X X

29
30 WORLD DEVELOPMENT

Table 2. Poverty projections from DHS data for Africa

Country Year $/day Poverty rates estimated from DHS On target?
(DHS for $/ poverty
First Last t-Statis- Sto- 1990 2015 Projections
years) day (%)
survey survey tic for chastic Esti-
poverty Linear Log-lin- Target Linear Log-
year year differ- domi- mate
(%) (%) ear (%) (%) linear
(%) (%) ence nance (%)
Burkina Faso (1992, 1999)
National 1994 61.2 60.5 62.3 1.85 ND 60.0 66.5 64.0 30.0 N N
Urban 6.3 5.4 )1.04 ND 6.5 3.4 4.5 3.3 N N
Rural 73.3 74.0 0.68 ND 73.1 75.8 74.7 36.5 N N
Ghana (1988, 1993, 1998)
National 1998 38.8 53.8 37.5 )15.18 1þ 50.5 9.6 26.1 25.3 Y N
Urban 15.6 6.8 )6.80 1þ 13.8 0 0.6 6.9 Y Y
Rural 72.9 54.9 14.66 1þ 69.3 24.2 42.3 34.6 Y N
Kenya (1988, 1993, 1998)
National 1994 26.5 28.6 25.0 )4.38 ND 27.9 18.8 22.5 14.0 N N
Urban 1.5 1.2 )0.78 ND 1.5 0.5 1.0 0.7 Y N
Rural 34.4 31.5 )2.83 ND 33.8 26.6 29.5 16.9 N N
Madagascar (1992, 1997)
National 1997 63.4 73.2 63.3 )12.26 1þ 77.2 27.6 48.8 38.6 Y N
Urban 14.4 29.1 11.31 ND 8.6 82.0 50.6 4.3 N N
Rural 84.7 74.4 )12.37 1þ 88.8 37.5 59.3 44.4 Y N
Mali (1987, 1995)
National 1994 72.8 81.4 71.6 )10.13 1þ 77.7 46.9 61.9 38.9 N N
Urban 35.6 28.3 )4.05 ND 32.9 9.8 21.1 16.4 Y N
Rural 96.3 90.3 )8.81 1þ 94.0 75.3 84.4 47.0 N N
Niger (1992, 1997)
National 1995 61.4 63.6 59.8 )4.15 ND 65.1 45.9 54.2 32.6 N N
Urban 14.8 11.3 )3.16 ND 16.2 0 6.2 8.1 Y Y
Rural 72.9 70.4 )2.34 ND 73.9 61.5 66.7 36.9 N N
Nigeria (1990, 1999)
National 1997 70.2 77.2 68.2 )11.03 1þ 77.2 52.4 61.5 38.6 N N
Urban 37.4 36.5 )0.57 ND 37.4 35.1 35.8 18.7 N N
Rural 91.0 82.4 )11.14 1þ 91.0 67.1 76.0 45.5 N N
Senegal (1986, 1992, 1997)
National 1995 26.3 29.1 25.7 )2.66 2) 27.9 20.0 23.4 13.9 N N
Urban 7.5 0.9 )5.25 ND 5.1 0 0 2.5 Y Y
Rural 42.1 43.3 0.38 2) 42.5 45.1 44.1 21.3 N N
Tanzania (1991, 1996, 1999)
National 1993 57.0 58.8 49.2 )9.54 ND 60.0 30.0 41.2 30.0 Y N
Urban 20.3 11.0 )6.86 1þ 21.5 0 3.3 10.7 Y Y
Rural 70.7 62.0 )7.27 ND 71.7 44.5 54.8 35.9 N N
Zambia (1992, 1996)
National 1998 63.7 51.9 59.8 9.15 ND 48.0 97.1 74.9 24.0 N N
Urban 9.0 11.1 2.43 ND 7.9 21.3 15.1 3.9 N N
Rural 86.7 88.4 2.44 2þ 85.8 96.7 91.6 42.9 N N
Zimbabwe (1988, 1994)
National 1990 36.0 33.8 40.5 5.83 1) 36.0 63.9 49.6 18.0 N N
Urban 0.3 2.1 3.93 1) 0.9 8.2 4.6 0.5 N N
Rural 50.0 58.3 5.80 1) 52.8 87.3 69.6 26.4 N N
*
Indicates significance at the 10% level.
**
Indicates significance at the 1% level.
***
Indicates significance at the 5% level.
 MILLENNIUM DEVELOPMENT GOALS IN AFRICA
than, or nearly equal to the target path. In all
these countries, with the exception of Kenya
with its initially very low rate of urban poverty,
we also observe statistically significant declines.
We are not however, able to reject the null of
nondominance in the cases of Kenya, Mali,
Niger and Senegal, indicating that the results of
poverty comparisons are sensitive to the choice
of poverty lines and poverty measures. While
we observe little if any marked change in levels
of poverty in many cases, poverty worsens in
urban areas in Zambia and Zimbabwe, as it did
in rural areas. This is also the case in urban
Madagascar. 20
When we look at the data on enrollment
rates for children six through 14 years of age
(see Table 3), again we find that they are higher
in urban than rural areas in each country.
There is also a large divergence in enrollments
across countries, with those in Niger being the
lowest, and those in Zimbabwe being the
highest. In terms of changes over survey peri-
ods, we find that Kenya is the only country
where the experience over the segment for
which we have data puts them on a (linear and/
or log-linear) path to realize the goal of 100%
enrollments in rural and urban areas. This
follows, in part, from the already relatively high
enrollment rate of 77% in 1993. Urban Cam-
eroon is the only other case where the linear
projections are consistent with achieving the
goal of universal enrollment; although this not
the case if enrollment rates increase in a log-
linear fashion. 21
The rates of improvement over the period
for which we have data are also quite rapid
in urban and rural Niger as well as urban
Tanzania, putting them close to reaching the
development goal for enrollments. Enrollments
in Nigeria also increased markedly and signifi-
cantly in statistical terms over the span of the
nine years between the DHS surveys. We do
have some worrisome findings in a few cases
where the enrollment situation worsens over
time. Statistically significant declines occurred
in urban and rural Zambia and Zimbabwe; al-
though, in the case of the latter, the declines are
small in magnitude. Enrollment rates have also
fallen in urban Madagascar over the five-year
period for which data are available.
In terms of the bias against girls in school
enrollments (see Table 4), we find that as with
other indicators, the situations during the base
survey years were worse in rural areas than in
urban areas in all countries, with the exception
of Tanzania. Some of these urban–rural differ-
31
ences are large, particularly in the two Sahelian
countries in our sample, Burkina Faso and
Niger. For example, the ratio of girls-to-boys
enrolled in rural Niger during the base survey
period of 1992 is an astonishingly low 0.39.
In terms of changes over time, only rural
Madagascar and Tanzania are on target to
meet the goal of gender equality in primary and
secondary education, though this only holds for
Madagascar if the observed rates of change
persist to the year 2015 in a linear fashion. This
is also the case in urban areas of Burkina Faso,
Tanzania and Zimbabwe. For Burkina Faso,
this accomplishment may occur despite the
initially low ratio for urban areas of 79.4, and is
a result of the fact that there has been sub-
stantial progress in observed enrollments of
girls in the years between the surveys. In rural
Niger and Nigeria, there has been statistically
significant progress as measured by increasing
ratios of girls-to-boys enrolled in primary and
secondary school, but the pace of change––
whether we assume linear or log-linear chan-
ges––in each of these countries is below the
linear target path. In a few countries, we actu-
ally observe worsening performances in terms
of gender equity in enrollments. This is most
pronounced in urban areas of Madagascar
(where overall enrollments are also falling),
Nigeria and Zambia, as well as both urban
and rural Kenya. While at first glance the rates
of decline in the ratios are sufficiently large
to be a cause of serious concern, in fact they
are only statistically significant in the case of
Madagascar.
Next we turn to a discussion of the results of
our two health indicators, infant mortality and
chronic child malnutrition, or stunting. Al-
though the evidence for both of these indicators
is mixed, the now common feature of urban
areas being better off than rural areas generally
applies here as well. With regard to infant
mortality, we have measurements for the entire
sample of 24 countries. Since we rely on ret-
rospective recall data, we can include any
country in our analysis provided that there
exists at least one DHS dataset. We also can
construct the longest time series, once again,
owing to the reliance on recall.
In terms of targets, with the exception of
Kenya, and one spell in Cameroon and Zam-
bia, all countries witnessed declines in national
IMR (Table 5). When we disaggregate by re-
gion, the declining rate of infant mortality is
generally greater in rural than urban areas. In
the case of rural areas, however, we do not get
32 WORLD DEVELOPMENT

Table 3. Enrollment rates for children of age 6–14

Country First survey Last survey t-Statistic for 1990 2015 Projections On target?
(DHS years) year (%) year (%) difference (%)
Linear Log-linear Target Linear Log-
(%) (%) linear
Burkina Faso (1992, 1999)
National 26.9 24.8 )3.25 27.5 20.0 22.8 100 N N
Urban 65.4 68.8 2.46 64.4 76.5 72.0 100 N N
Rural 19.5 18.3 )1.67 19.8 15.7 17.2 100 N N
Cameroon (1991, 1998)
National 68.4 74.5 7.28 67.6 89 80.5 100 N N
Urban 76.7 86.7 9.63 75.3 100 96.6 100 Y N
Rural 63.6 68.9 4.43 62.8 81.9 74.3 100 N N
Ghana (1993, 1998)
National 76.0 77.2 1.53 75.3 81.2 78.8 100 N N
Urban 86.4 87.1 0.54 86.0 89.2 88.0 100 N N
Rural 71.3 73.2 1.86 70.2 79.3 75.7 100 N N
Kenya (1993, 1998)
National 76.8 87.4 20.61 70.5 100 100 100 Y Y
Urban 78.7 88.0 5.43 73.2 100 100 100 Y Y
Rural 76.6 87.3 19.80 70.2 100 100 100 Y Y
Madagascar (1992, 1997)
National 56.2 58.1 2.42 55.5 64.8 60.8 100 N N
Urban 79.7 76.7 )2.40 80.9 66.1 72.4 100 N N
Rural 52.2 52.4 0.25 52.1 53.2 52.7 100 N N
Niger (1992, 1997)
National 16.1 22.9 11.55 13.5 47.0 32.7 100 N N
Urban 44.2 55.5 9.05 39.8 95.9 71.9 100 N N
Rural 10.3 14.6 7.07 8.6 29.9 20.8 100 N N
Nigeria (1990, 1999)
National 56.7 64.7 12.25 56.7 78.9 70.6 100 N N
Urban 75.3 77.8 2.58 75.3 82.3 79.7 100 N N
Rural 50.8 59.4 10.50 50.8 74.7 65.8 100 N N
Tanzania (1991, 1996, 1999)
National 46.5 49.6 3.69 46.1 55.8 52.1 100 N N
Urban 51.8 66.7 8.57 50.0 96.3 79.0 100 N N
Rural 45.1 45.3 0.20 45.1 45.7 45.4 100 N N
Zambia (1992, 1996)
National 70.8 60.2 )15.62 76.1 9.9 40.0 100 N N
Urban 83.2 72.9 )10.62 88.4 23.7 53.1 100 N N
Rural 59.3 52.3 )7.66 62.8 19.1 39.0 100 N N
Zimbabwe (1988, 1994)
National 84.9 83.3 )2.75 84.4 77.7 81.1 100 N N
Urban 90.7 87.4 )2.83 89.6 75.9 82.9 100 N N
Rural 83.4 82.1 )2.06 83.0 77.3 80.2 100 N N
*
Indicates significance at the 10% level.
**
Indicates significance at the 1% level.
***
Indicates significance at the 5% level.

statistically significant declines in seven of 24 significant fashion in Burkina Faso during

countries: Comoros, C^ ote dÕIvoire, Malawi, 1989–98, and in Zambia during 1982–95. In
Namibia, Tanzania, Zambia and Zimbabwe. In only 11 of the 24 countries is the improvement
urban areas, this applies to 16 of 24 countries, of infant mortality in rural areas great enough
with infant mortality rising in a statistically to realize the goal of reducing IMR by two-
 MILLENNIUM DEVELOPMENT GOALS IN AFRICA 33

Table 4. Ratio of girls-to-boys enrolled in primary and secondary schools

Country First survey Last survey t-Statistic 1990 2015 Projections On target?
(DHS year year for differ-
Linear Log-linear Target Linear Log-
years) (ratio  100) (ratio  100) ence
(ratio  100) (ratio  100) linear
Burkina Faso (1992, 1999)
National 66.0 67.5 0.44 65.6 70.6 68.8 100 N N
Urban 79.4 90.7 2.24 76.2 100 95.7 100 Y N
Rural 56.0 53.4 )0.59 56.7 47.4 50.9 100 N N
Cameroon (1991, 1998)
National 86.2 87.0 0.11 86.1 87.3 86.8 100 N N
Urban 91.2 91.1 )0.02 91.2 91.0 91.0 100 N N
Rural 82.1 83.3 0.26 81.9 84.5 83.9 100 N N
Ghana (1993, 1998)
National 81.0 86.6 1.75 77.6 100 94.6 100 Y N
Urban 90.0 89.8 )0.03 90.1 89.6 89.7 100 N N
Rural 76.2 85.0 2.26 71.0 97.3 91.3 100 N N
Kenya (1993, 1998)
National 98.0 93.6 )1.75 100.6 78.5 87.3 100 N N
Urban 101.5 92.7 )1.03 106.7 80.4 86.4 100 N N
Rural 97.6 93.7 )1.49 100.0 88.1 90.8 100 N N
Madagascar (1992, 1997)
National 94.0 91.9 )0.58 94.7 84.8 89.0 100 N N
Urban 96.3 84.7 )2.29 100.9 66.1 75.2 100 N N
Rural 93.1 96.2 0.67 91.9 100 98.7 100 Y N
Niger (1992, 1997)
National 56.3 65.8 2.96 52.4 100 79.7 100 Y N
Urban 77.0 85.8 1.79 73.4 99.9 93.0 100 N N
Rural 39.1 46.8 1.65 36.0 59.2 53.2 100 N N
Nigeria (1990, 1999)
National 81.2 83.6 0.95 81.2 87.5 85.2 100 N N
Urban 91.5 86.7 )1.22 91.5 83.5 85.0 100 N N
Rural 76.6 81.8 1.69 76.6 85.3 83.6 100 N N
Tanzania (1991, 1996, 1999)
National 88.3 105.2 4.23 86.2 100 100 100 Y Y
Urban 80.4 111.4 4.22 76.5 100 100 100 Y Y
Rural 91.0 103.0 2.46 89.5 100 100 100 Y Y
Zambia (1992, 1996)
National 92.2 88.3 )1.38 94.1 70.0 80.9 100 N N
Urban 97.9 92.1 )1.37 100.8 78.9 85.4 100 N N
Rural 84.7 84.8 0.01 84.7 84.9 84.8 100 N N
Zimbabwe (1988, 1994)
National 90.2 91.6 0.52 89.0 96.3 93.6 100 N N
Urban 93.5 97.3 0.60 90.4 100 99.6 100 Y N
Rural 89.3 89.7 0.13 88.9 90.2 89.9 100 N N
*
Indicates significance at the 10% level.
**
Indicates significance at the 1% level.
***
Indicates significance at the 5% level.

thirds by 2015 (Table 6), when linear projec-
tions are employed. Using log-linear projec-
tions, we find that in only four countries are the
mortality rates falling fast enough. 22 Of the 15
countries in which IMR were observed to fall in
urban areas, only in C^ ote dÕIvoire, Ghana,
Mali, and Namibia are the changes rapid
enough to meet the target.
In considering the results on IMR, the role
and implications of the HIV/AIDS crisis clearly
34 WORLD DEVELOPMENT

Table 5. Annual rates of change in infant mortality

Country Years Annual change per 1,000 livebirths
Rural t-Statistic Urban t-Statistic National t-Statistic
1 Benin 1986–95 )6.74 )2.86 
0.28 0.11 )4.60 )2.35
2 Burkina Faso 1982–98 )2.90 )2.91 )2.56 )2.68
1982–91 )6.01 )2.33
1989–98 9.45 2.60
3 Burundi 1977–86 )8.88 )7.21 6.98 2.89 )8.37 )6.86
4 Cameroon 1981–97 )1.66 )1.71 )1.24 )1.13
1981–90 )5.91 )4.30
1988–97 4.27 2.20
5 CAR 1984–93 )3.04 )1.89 )1.72 )1.19 )2.50 )1.88
6 Chad 1987–96 )5.74 )3.62 )0.25 )0.20 )4.62 )3.45
7 Comoros 1986–95 )4.78 )1.63 )0.43 )0.11 )3.74 )1.37
8 C^
ote dÕIvoire 1984–93 )3.60 )1.64 )2.22 )1.62 )3.10 )1.82
9 Ghana 1978–97 )2.80 )5.00 )2.19 )3.63 )2.59 )5.91
10 Kenya 1978–97 0.67 1.81 0.96 0.99 0.61 1.82
11 Madagascar 1982–96 )2.57 )3.25 )1.91 )1.78 )2.63 )3.50
12 Malawi 1982–91 )0.83 )0.43 2.98 0.98 )0.41 )0.22
13 Mali 1977–94 )3.69 )2.79 )2.85 )2.65 )3.55 )3.10
14 Mozambique 1987–96 )13.10 )2.87 0.50 0.14 )10.33 )2.86
15 Namibia 1982–91 )1.91 )1.48 )3.41 )1.06 )2.39 )1.70
16 Niger 1982–96 )2.93 )2.62 )2.26 )2.73 )2.91 )2.82
17 Nigeria 1980–98 ) 2.36 )3.70 )0.51 )0.54 )2.01 )3.63
18 Rwanda 1982–91 )3.04 )2.82 4.20 1.18 )2.64 )2.25
19 Senegal 1976–96 )2.67 )5.39 )3.00 )7.33
1976–85 )9.02 )5.55
1982–91 5.96 2.59
1987–96 8.59 3.74
20 Tanzania 1981–98 )0.70 )0.68 )1.56 )1.07 )0.87 )1.06
21 Togo 1978–97 )1.55 )2.97 )0.60 )0.59 )1.34 )2.90
22 Uganda 1978–94 )3.01 )3.37 )3.09 )3.29 )3.05 )3.74
23 Zambia 1982–95 )0.17 )0.19 5.08 3.79
1982–91 3.93 2.75
1986–95 )4.75 )2.36
24 Zimbabwe 1978–98 )0.14 )0.22 1.11 1.64
1978–87 )3.74 )2.74
1984–93 4.55 2.36
1989–98 6.70 3.46
*
Indicates significance at the 10% level.
**
Indicates significance at the 1% level.
***
Indicates significance at the 5% level.

deserves mention. As noted above, with few
notable exceptions such as urban Zambia and
Zimbabwe (with particularly high rates of
HIV), our empirical observations indicate that
IMR have fallen during the periods for which
we have data––despite the AIDS epidemic.
These declines in the face of the effects of HIV/
AIDS may be attributed to several factors.
First, increased mortality associated with HIV
had yet to contribute to large increases in
overall mortality in the periods before the late
1990s. Because much of our data stops in the
mid 1990s, we do not pick up many of the child
deaths attributed to HIV/AIDS. Second, and
perhaps even more important, the overall affect
of the epidemic on infant mortality is far less
than on mortality rates of other age cohorts,
particularly young adults. This reflects the fact
that the rate of mother to child transmission of
HIV in Africa is estimated to be approximately
30% (Preble, 1990). Further, among those cases
where there is positive transmission, the prob-
ability of dying during the first year of life from
AIDS is estimated to be only 15% (Preble, 1990).
 MILLENNIUM DEVELOPMENT GOALS IN AFRICA 35

Table 6. IMR
Country 1990 2015 Projections On target?
(DHS years)
Linear Log-linear HIV-adjusted HIV-adjusted Target Linear Log-linear
linear log-linear
Deaths before the age of 12 months per 1,000 livebirths
Benin (1996)
National 110.0 0 50.5 2.0 52.4 37 Y N
Urban 91.2 98.1 94.8 99.1 95.8 30 N N
Rural 118.6 0 31.5 2.6 34.1 40 Y Y
Burkina Faso (1992, 1999)
National 129.1 65.1 90.7 67.8 93.4 43 N N
Urban 67.7 153.8 119.4 156.4 122.0 23 N N
Rural 135.6 63.0 92.0 65.7 94.7 45 N N
Burundi (1987)
National 35.7 0 0 2.0 2.0 12 Y Y
Urban 149.8 281.5 173.2 281.5 173.2 50 N N
Rural 31.6 0 0 1.8 1.8 11 Y Y
Cameroon (1991, 1998)
National 91.0 50.0 67.5 53.6 71.1 30 N N
Urban 72.0 40.9 54.2 43.4 56.7 24 N N
Rural 91.1 49.5 67.3 53.6 71.4 30 N N
Central African Republic (1994)
National 101.7 39.2 73.1 45.4 79.3 34 N N
Urban 79.3 36.3 59.6 41.6 64.9 26 N N
Rural 116.5 40.5 88.7 47.4 95.6 39 N N
Chad (1997)
National 130.9 15.5 67.9 18.8 71.2 44 Y N
Urban 116.9 110.7 113.5 113.7 116.5 39 N N
Rural 134.9 0 56.6 3.4 60.0 45 Y N
Comoros (1996)
National 83.6 0 35.2 0 35.2 28 Y N
Urban 58.8 48.0 53.2 48.0 53.2 20 N N
Rural 91.5 0 29.7 0 29.7 31 Y Y
C^
ote d’Ivoire (1994)
National 89.5 12.1 54.1 15.6 57.6 30 Y N
Urban 72.8 17.2 47.4 21.3 51.5 24 Y N
Rural 98.0 8.0 56.9 11.2 60.1 33 Y N
Ghana (1993, 1998)
National 77.9 13.2 40.8 14.6 42.2 26 Y N
Urban 57.7 2.9 26.3 4.1 27.5 19 Y N
Rural 85.3 15.4 45.2 16.9 46.7 28 Y N
Kenya (1993, 1998)
National 69.8 85.1 78.6 91.8 85.3 23 N N
Urban 57.9 81.9 71.7 89.4 79.2 19 N N
Rural 72.0 88.7 81.6 95.2 88.1 24 N N
Madagascar (1992, 1997)
National 106.4 40.8 70.6 40.9 70.7 35 N N
Urban 80.9 33.1 54.8 33.1 54.8 27 N N
Rural 111.9 47.6 76.9 47.8 77.1 37 N N
Malawi (1992)
National 146.8 136.6 142.8 142.4 148.6 49 N N
Urban 138.4 213.0 167.7 225.8 180.5 46 N N
Rural 148.0 127.3 139.9 132.1 144.7 49 N N
(Continued on next page)
36 WORLD DEVELOPMENT

Table 6—continued
Country 1990 2015 Projections On target?
(DHS years)
Linear Log-linear HIV-adjusted HIV-adjusted Target Linear Log-linear
linear log-linear
Mali (1987, 1995)
National 142.7 53.8 99.3 55.0 100.5 48 N N
Urban 106.3 35.0 71.5 36.1 72.6 35 Ya N
Rural 155.3 63.1 110.3 64.2 111.4 52 N N
Mozambique (1997)
National 172.4 0 31.6 6.9 38.5 57 Y Y
Urban 89.5 102.0 96.3 106.5 100.8 30 N N
Rural 192.4 0 13.8 7.7 21.5 64 Y Y
Namibia (1992)
National 59.7 0 36.2 7.4 43.6 20 Y N
Urban 54.3 0 20.8 10.2 31.0 18 Y N
Rural 62.5 14.7 43.7 20.4 49.4 21 Y N
Niger (1992, 1997)
National 154.6 81.8 114.9 82.8 115.9 52 N N
Urban 93.8 37.3 63.0 38.2 63.9 31 N N
Rural 166.3 93.0 126.3 93.9 127.2 55 N N
Nigeria (1990, 1999)
National 91.2 41.0 61.1 43.5 63.6 30 N N
Urban 75.2 62.6 67.6 65.6 70.6 25 N N
Rural 96.7 37.8 61.3 40.1 63.6 32 N N
Rwanda (1992)
National 88.5 22.4 62.5 25.7 65.8 29 Y N
Urban 103.8 208.9 145.1 214.9 151.1 35 N N
Rural 87.5 11.6 57.7 14.8 60.9 29 Y N
Senegal (1986, 1992, 1997)
National 83.3 8.3 42.4 8.5 42.6 28 Y N
Urban 56.4 0 20.1 0.2 20.3 19 Y N
Rural 97.4 86.7 91.6 86.9 91.8 32 N N
Tanzania (1991, 1996, 1999)
National 109.9 88.1 96.9 94.5 103.2 37 N N
Urban 97.5 58.5 74.1 65.6 81.2 33 N N
Rural 113.2 95.8 102.8 101.9 108.9 38 N N
Togo (1988, 1998)
National 90.0 56.4 70.7 58.8 73.2 30 N N
Urban 77.9 62.9 69.3 66.0 72.4 26 N N
Rural 94.3 55.6 72.1 57.7 74.2 31 N N
Uganda (1988, 1995)
National 97.9 21.7 60.8 24.4 63.4 33 Y N
Urban 87.8 10.6 50.2 15.7 55.3 29 Y N
Rural 99.3 24.1 62.7 26.4 65.0 33 Y N
Zambia (1992, 1996)
National 118.4 97.8 107.7 105.8 115.8 39 N N
Urban 99.6 226.7 165.3 238.9 177.5 33 N N
Rural 124.8 120.6 122.6 125.2 127.2 42 N N
Zimbabwe (1988, 1994)
National 54.0 127.9 98.3 142.9 113.4 18 N N
Urban 46.0 73.8 62.7 86.4 75.3 15 N N
Rural 65.1 61.5 62.9 78.2 79.6 22 N N
a
Target only achieved for nonadjusted projection.
 MILLENNIUM DEVELOPMENT GOALS IN AFRICA 37

So consider, for example, a country where the
prevalence rate among pregnant women is high
(15%). The impact of mother-to-child trans-
mission of HIV on infant mortality will be less
than seven deaths per 1,000 livebirths. If overall
infant mortality is 100 or above, as it is in
many African countries, the impact of HIV/
AIDS as a percentage of total infant mortality
will be limited relative to the deaths from other
causes.
As we look ahead, the impact of HIV/AIDS
on infant mortality is also quite uncertain. On
the one hand, we recognize that––given the
ravages of HIV/AIDS––making projections
based on the changes in mortality during the
late 1970s through the early 1990s may not be
meaningful in much of sub-Saharan Africa. On
the other hand, in the medium to short-term,
there are reasons to be hopeful that anti-ret-
rovirals (ARVs) will substantially reduce
mother-to-child transmission. This should re-
duce the number of AIDS-related deaths
among infants and contribute to acceleration in
the improvements witnessed during the past
few years, or at least should not reverse the
trend. In addition, there is some reason to hope
that behavioral changes will lead to a reduction
in the share of pregnant women with HIV. But
of course, important obstacles remain in terms
of making widely available the ARVs and other
interventions that may lower adult prevalence
rates.
In any event, in Table 6 we have shown an
alternative HIV-adjusted predictive path for
infant mortality that is based on four strong
assumptions. First, we assume that HIV prev-
alence rates among pregnant women remain
fixed at the most recently estimated levels.
(Table 7 presents the seroprevalence rates for
pregnant women in urban and rural areas.)
Second, we assume that there is no reduction in
mother to child transmission rates. This as-
sumption, coupled with evidence that 15% of
the HIV-positive children will die in their first
year of life leads to increased levels of mortal-
ity associated with HIV/AIDS (also shown in
Table 7). Third, we assume that none of the
children who die of HIV/AIDS would have
died due to other causes. Finally, we assume
that for the period in which we have data, there

Table 7. HIV-1 seroprevalence rates and mortality adjustments

Country (DHS years) HIV-1 seroprevalence rate Increase in IMR due to HIV/AIDSa
National Urban Rural National Urban Rural
Benin (1996) 4.3 2.3 5.7 2.0 1.0 2.6
Burkina Faso (1992, 1999) 5.9 5.7 6.0 2.7 2.6 2.7
Burundi (1987) 4.5 18.6 3.9 2.0 8.4 1.8
Cameroon (1991, 1998) 7.9 5.6 9.2 3.6 2.5 4.1
Central African Republic (1994) 13.8 11.7 15.3 6.2 5.3 6.9
Chad (1997) 7.3 6.7 7.5 16.5 15.1 16.9
Comoros (1996) 0 0 0 0 0 0
C^
ote dÕIvoire (1994) 7.9 9.0 7.1 3.6 4.1 3.2
Ghana (1993, 1998) 3.1 2.7 3.4 1.4 1.2 1.5
Kenya (1993, 1998) 14.9 16.7 14.4 6.7 7.5 6.5
Madagascar (1992, 1997) 0.3 0.1 0.4 0.1 0.0 0.2
Malawi (1992) 12.9 28.5 10.7 5.8 12.8 4.8
Mali (1987, 1995) 2.5 2.5 2.5 1.1 1.1 1.1
Mozambique (1997) 15.3 9.9 17.0 6.9 4.5 7.7
Namibia (1992) 16.5 22.7 12.6 7.4 10.2 5.7
Niger (1992, 1997) 2.1 2.1 2.1 0.9 0.9 0.9
Nigeria (1990, 1999) 5.5 6.7 5.0 2.5 3.0 2.3
Rwanda (1992) 7.4 13.3 7.0 3.3 6.0 3.2
Senegal (1986, 1992, 1997) 0.5 0.4 0.5 0.2 0.2 0.2
Tanzania (1991, 1996, 1999) 14.1 15.8 13.5 6.4 7.1 6.1
Togo (1988, 1998) 5.4 6.8 4.6 2.4 3.1 2.1
Uganda (1988, 1995) 6.0 11.4 5.0 2.7 5.1 2.3
Zambia (1992, 1996) 17.8 27.1 10.3 8.0 12.2 4.6
Zimbabwe (1988, 1994) 33.5 28.0 37.0 15.1 12.6 16.7
Source: Center for International Research, US Bureau of the Census (2002).
a
Deaths per 1,000 livebirths.
38 WORLD DEVELOPMENT

Table 8. Percent of children under five years of age who are stunted percentage height-for-age z-score less than
2
Country First Second t-Statistic Stochastic 1990 (%) 2015 Projections On target?
(DHS years) survey survey for differ- dominance
Linear Log-lin- Target Linear Log-
year (%) year (%) ence
(%) ear (%) (%) linear
Burkina Faso (1992, 1999)
National 33.4 37.0 2.91 1) 32.3 45.3 40.5 10.8 N N
Urban 20.0 22.7 1.66 1) 19.3 28.9 25.3 6.4 N N
Rural 35.9 39.0 2.32 1) 35.0 46.3 42.0 11.7 N N
Cameroon (1991, 1998)
National 25.6 29.9 2.99 1) 25.0 40.1 34.1 8.3 N N
Urban 17.0 22.6 3.39 1) 16.2 36.1 28.2 5.4 N N
Rural 31.5 32.5 0.56 2) 31.4 34.8 33.4 10.5 N N
Ghana (1988, 1993, 1998)
National 29.9 26.1 )2.75 1þ 29.2 19.6 23.4 9.7 N N
Urban 25.1 14.6 )4.25 2þ 23.0 0 7.4 7.7 Y Y
Rural 31.9 29.9 )1.19 ND 31.5 26.5 28.5 10.5 N N
Kenya (1993, 1998)
National 33.8 33.6 )0.19 ND 33.9 33.0 33.4 11.3 N N
Urban 22.0 25.7 1.39 ND 19.8 38.2 30.8 6.6 N N
Rural 35.3 35.2 )0.07 ND 35.4 35.0 35.1 11.8 N N
Madagascar (1992, 1997)
National 54.5 48.8 )4.67 ND 56.8 28.2 40.4 18.9 N N
Urban 45.0 45.2 0.08 ND 44.9 46.0 45.5 15.0 N N
Rural 56.0 49.6 )4.56 ND 58.5 26.7 40.3 19.5 N N
Mali (1987, 1995)
National 24.0 29.9 3.83 1) 26.2 44.7 35.8 8.7 N N
Urban 19.6 21.5 0.92 2) 20.3 26.3 23.4 6.8 N N
Rural 26.3 32.9 2.99 1) 28.8 49.5 39.5 9.6 N N
Niger (1992, 1997)
National 39.7 41.3 1.47 2) 39.1 47.2 43.7 13.0 N N
Urban 27.4 31.5 2.25 ND 25.7 46.4 37.6 8.6 N N
Rural 42.5 43.3 0.52 ND 42.2 45.8 44.3 14.1 N N
Nigeria (1990, 1999)
National 43.2 47.0 2.49 2) 43.2 53.7 49.8 14.4 N N
Urban 35.1 43.0 2.94 2) 35.1 57.0 48.8 11.7 N N
Rural 45.7 48.5 1.59 2) 45.7 53.7 50.7 15.2 N N
Senegal (1986, 1992, 1997)
National 23.3 24.8 0.83 ND 23.8 27.3 25.8 7.9 N N
Urban 17.5 15.1 )0.86 ND 16.6 11.3 13.6 5.5 N N
Rural 26.6 30.7 1.66 2) 28.1 37.3 33.4 9.4 N N
Tanzania (1991, 1996, 1999)
National 43.9 42.6 )1.02 ND 44.0 40.2 41.6 14.7 N N
Urban 38.2 24.6 )5.88 ND 39.9 0 13.2 13.3 Y Y
Rural 45.3 46.5 0.87 ND 45.2 48.8 47.5 15.1 N N
Togo (1988, 1998)
National 29.7 22.0 )5.42 1þ 24.5 0 0 8.2 Y Y
Urban 21.2 14.9 )2.58 1þ 17.0 0 0 5.7 Y Y
Rural 33.1 24.1 )5.20 2þ 27.1 0 0 9.0 Y Y
Uganda (1988, 1995)
National 44.8 39.3 )4.79 1þ 43.3 23.7 33.2 14.4 N N
Urban 25.8 23.4 )1.09 ND 25.1 16.5 20.6 8.4 N N
Rural 46.7 41.6 )3.87 1þ 45.2 27.1 35.9 15.1 N N
 MILLENNIUM DEVELOPMENT GOALS IN AFRICA 39

Table 8—continued
Country First Second t-Statistic Stochastic 1990 (%) 2015 Projections On target?
(DHS years) survey survey for differ- dominance
Linear Log- Target Linear Log-
year (%) year (%) ence
(%) linear (%) (%) linear
Zambia (1992, 1996)
National 40.2 42.8 2.73 1) 45.3 61.9 54.3 15.1 N N
Urban 33.0 33.1 0.11 ND 32.9 33.9 33.5 11.0 N N
Rural 46.6 49.3 2.10 2) 45.3 61.9 54.3 15.1 N N
Zimbabwe (1988, 1994)
National 29.1 27.1 )1.58 2þ 32.4 16.1 24.5 10.8 N N
Urban 14.5 21.5 3.20 ND 16.8 46.1 31.1 5.6 N N
Rural 33.7 29.8 )2.59 1þ 32.4 16.1 24.5 10.8 N N
*
Indicates significance at the 10% level.
**
Indicates significance at the 1% level.
***
Indicates significance at the 5% level.

are no HIV related deaths (since we are
assuming that the AIDS shock is additional to
the changes that have already occurred in the
IMRs). This latter assumption is clearly the
most extreme. Further, it is most obviously not
correct in such cases as Zimbabwe and Zambia
where the epidemic hit early and hard, and
where the increased IMRs undoubtedly already
capture the effect of mother-to-child transmis-
sion.
The results indicated that the overall impact
of our HIV adjustment on the IMR projections
is quite modest in most cases. Obvious excep-
tions include those countries with high sero-
prevalence, such as Namibia and Malawi. In
the case of the former, the log-linear projection
for IMR in urban areas is 31 using our HIV
adjustment, versus only 21 without. In urban
Malawi, the comparable figures are 181 based
on the assumptions above, versus only 169
otherwise.
Our examination of changes in health out-
comes using child anthropometric measures
provides some additional insights that are not
always consistent with the story we get from
looking at changes and levels of infant mor-
tality. We employ the same target as is used for
mortality: a two-thirds reduction of the percent
of children who are stunted. In Table 8, we find
that the percent of malnourished children is
greater in rural areas than urban areas in all
countries for which we have data. Only in
urban areas in Ghana, Tanzania and Togo, as
well as rural areas in Togo, do we observe de-
clines in stunting that are consistent with
meeting the target (both linearly and log-lin-
early). In case of Tanzania, however, we are
unable to reject the null of nondominance when
comparing the levels of malnutrition between
the two periods, and we are only able to do so
using second-order conditions in urban Ghana
and rural Togo, despite the fact that the point
estimates are all statistically different. In rural
areas of Uganda and Zimbabwe, the rates of
malnutrition fall, but not fast enough to keep
pace with linear projections needed to cut
malnutrition by two-thirds. Nevertheless, in
both cases, we are able to reject the null of
nondominance implying unambiguous im-
provements in the nutrition of the pre-school
age child populations in these countries.
In many countries, malnutrition shows no
improvement or actually worsens. Malnutrition
in rural and urban areas in Burkina Faso,
Cameroon, Mali, Niger, and Nigeria, as well as
rural Madagascar, Senegal and Zambia deteri-
orated over the periods spanned by the re-
spective surveys.
We now turn to the analysis of two MDG for
which there are no precise measures in the
DHS: access to reproductive health services
and maternal mortality. In the case of maternal
mortality, we have a reasonable, but far from
perfect proxy measure––the number of births
attended by skilled health personnel. Like in-
fant mortality, these data come from recall in-
formation that allows us to construct a longer
data series than the periods between surveys.
Before discussing the prognoses for realizing
the development goal, we should first highlight
the large disparities in the percentage of births
attended by qualified personnel both across
countries and between rural and urban areas
(Table 9). The figures from rural Chad and
40 WORLD DEVELOPMENT

Table 9. Percentage of births attended by skilled health personnel

Country Last survey Annual rate t-Statistic 1990 2015 Projections On target?
(DHS years) year (%) of change for rate of (%)
Linear Log-linear Target Linear Log-linear
change
(%) (%) (%)
Benin (1996)
National 63.2 )1.0 )2.56 69.0 44.8 55.8 90 N N
Urban 80.1 )0.1 )0.29 80.9 77.6 79.1 90 N N
Rural 55.7 )1.0 )2.89 61.9 36.1 47.8 90 N N
Burkina Faso (1992, 1999)
National 28.0 )1.4 )5.54 40.8 5.1 18.5 90 N N
Urban 92.0 0.1 0.61 91.1 93.7 92.7 90 Y Y
Rural 22.6 )1.1 )4.93 32.4 5.0 15.3 90 N N
Burundi (1987)
National 17.2 )0.9 )2.39 14.6 0 9.5 90 N N
Urban 81.1 )2.1 )2.51 74.9 23.4 62.8 90 N N
Rural 15.4 )0.7 )1.99 13.4 0 9.6 90 N N
Cameroon (1991, 1998)
National 57.4 )0.6 )1.38 61.8 48.0 53.5 90 N N
Urban 85.6 0.3 1.71 83.2 90.6 87.6 90 Y N
Rural 48.1 )0.2 )0.34 49.4 45.4 47.0 90 N N
Central African Republic (1994)
National 35.1 )15.0 )2.12 95.0 0 0 90 N N
Urban 74.1 )4.9 )2.45 93.9 0 33.7 90 N N
Rural 21.8 )2.0 )1.32 29.8 0 5.4 90 N N
Chad (1997)
National 11.4 )1.4 )3.26 21.4 0 0.9 90 N N
Urban 40.1 )1.9 )2.68 53.5 5.5 26.0 90 N N
Rural 4.9 )0.6 )3.03 9.4 0 0.2 90 N N
Comoros (1996)
National 50.9 )0.6 )3.49 54.6 39.0 46.1 90 N N
Urban 75.4 )3.5 )1.39 96.7 8.2 48.4 90 N N
Rural 45.3 1.4 2.86 36.9 71.9 55.9 90 N N
C^
ote d’Ivoire (1994)
National 40.3 )4.9 )5.78 59.8 0 0.3 90 N N
Urban 75.2 )0.5 )0.61 77.1 65.5 71.4 90 N N
Rural 27.1 )2.4 )13.07 36.6 0 7.7 90 N N
Ghana (1993, 1998)
National 45.8 0.3 1.94 43.1 51.5 48.2 90 N N
Urban 80.6 0.5 1.22 76.5 89.4 84.2 90 N N
Rural 34.2 0.4 2.29 31.3 40.4 36.8 90 N N
Kenya (1993, 1998)
National 42.1 )0.6 )3.05 47.0 31.6 37.8 90 N N
Urban 71.8 )0.6 )1.90 76.9 60.9 67.3 90 N N
Rural 35.9 )0.8 )3.77 42.2 22.7 30.5 90 N N
Madagascar (1992, 1997)
National 46.3 )1.3 )5.96 55.6 22.6 36.7 90 N N
Urban 68.6 )1.7 )3.99 80.5 38.3 56.3 90 N N
Rural 40.5 )1.5 )4.70 50.9 13.5 29.5 90 N N
Malawi (1992)
National 51.6 )1.8 )5.76 55.3 9.6 35.8 90 N N
Urban 86.4 0.4 0.41 85.6 95.5 89.9 90 Y N
Rural 47.5 )1.9 )4.00 51.4 2.8 30.7 90 N N
 MILLENNIUM DEVELOPMENT GOALS IN AFRICA 41

Table 9—continued
Country Last survey Annual rate t-Statistic 1990 2015 Projections On target?
(DHS years) year (%) of change for rate of (%)
Linear Log-linear Target Linear Log-linear
change
(%) (%) (%)
Mali (1987, 1995)
National 39.8 1.7 6.36 31.4 73.6 53.2 90 N N
Urban 80.1 1.0 2.39 75.3 99.4 87.7 90 Y N
Rural 26.0 1.6 6.11 18.3 57.1 38.3 90 N N
Mozambique (1997)
National 36.5 )5.3 )2.82 73.5 0 0 90 N N
Urban 87.3 3.1 3.07 65.7 100 100 90 Y Y
Rural 29.7 )3.0 )1.73 50.6 0 7.9 90 N N
Namibia (1992)
National 69.0 )0.1 )0.17 69.2 66.9 68.2 90 N N
Urban 88.4 0.6 1.21 87.3 100 93.6 90 Y Y
Rural 62.0 1.0 1.89 60.0 85.4 70.8 90 N N
Niger (1992, 1997)
National 17.6 0.3 1.50 15.5 22.9 19.7 90 N N
Urban 69.5 )0.1 )0.78 70.5 67.1 68.5 90 N N
Rural 7.8 0.4 3.27 5.2 14.4 10.5 90 N N
Nigeria (1990, 1999)
National 42.8 0.5 0.83 38.5 50.4 45.9 90 N N
Urban 58.3 )0.4 )1.51 61.7 52.2 55.8 90 N N
Rural 36.8 0.6 0.90 31.7 45.8 40.5 90 N N
Rwanda (1992)
National 26.5 0.2 0.59 26.1 31.1 28.2 90 N N
Urban 63.8 )1.6 )2.06 67.0 28.1 50.4 90 N N
Rural 24.4 0.2 0.57 24.0 29.2 26.2 90 N N
Senegal (1986, 1992, 1997)
National 52.8 1.6 6.99 41.2 82.4 64.8 90 N N
Urban 85.7 0.8 4.14 80.2 100 91.5 90 Y Y
Rural 35.6 1.7 7.77 23.6 66.5 48.2 90 N N
Tanzania (1991, 1996, 1999)
National 37.1 )2.2 )4.24 57.3 1.4 22.2 90 N N
Urban 78.0 )0.9 )3.17 86.5 63.0 71.8 90 N N
Rural 28.9 )2.3 )4.34 49.3 0 13.8 90 N N
Togo(1988, 1998)
National 49.7 0.2 1.36 47.8 53.6 51.3 90 N N
Urban 88.1 0.7 3.55 82.3 100 93.2 90 Y Y
Rural 39.0 0.3 1.61 36.9 43.5 40.9 90 N N
Uganda (1988, 1995)
National 35.2 )0.9 )1.63 39.8 17.0 28.0 90 N N
Urban 78.1 )0.5 )1.44 80.3 69.0 74.5 90 N N
Rural 31.3 )0.5 )1.94 33.9 20.9 27.2 90 N N
Zambia (1992, 1996)
National 44.3 )1.2 )2.29 51.2 22.5 35.5 90 N N
Urban 75.9 )0.7 )1.70 79.8 63.5 70.9 90 N N
Rural 25.0 )0.3 )0.92 26.9 18.9 22.5 90 N N
Zimbabwe (1988, 1994)
National 70.8 0.3 1.34 69.5 77.4 74.5 90 N N
Urban 91.1 0.0 0.28 90.7 91.8 91.4 90 Y Y
Rural 62.6 0.1 0.32 62.3 64.1 63.5 90 N N
*
Indicates significance at the 10% level.
**
Indicates significance at the 1% level.
***
Indicates significance at the 5% level.
42 WORLD DEVELOPMENT
Niger paint a particularly acute picture. In the
last years for which have survey data, only
4.9% and 7.8% of births in rural areas of these
countries, respectively, were attended by qual-
ified medical personnel. Contrast this with rural
Zimbabwe where the comparable figure was
over 62.6%. In urban areas in Burkina Faso
and Zimbabwe, qualified persons attend over
90% of the births, and in a number of other
countries the figures approach this level. We
should also add that the high value for Burkina
Faso is surprising. We admonish that deter-
mining whether personnel are ‘‘qualified’’ or
‘‘skilled’’ is a subjective undertaking, and con-
sequently we should treat cross country compar-
isons of this indicator with caution, despite the
comparability in the questionnaire and training
of enumerators in the various surveys.
In examining and interpreting our results
relative to the subject of interest––maternal
mortality––we should bear in mind that pro-
gress in increasing the number of qualified birth
attendants should be easier to achieve than
lowering maternal mortality rates. Thus, it is
not a good sign that the only cases where we
find statistically significant improvements con-
sistent with the linear rates of progress required
to realize the targets are urban areas in Cam-
eroon, Mali, Mozambique, Senegal and Togo.
There is virtually no realistic hope for rural
areas in any of the countries to meet the goal.
Although, rural areas of Comoros, Ghana,
Mali, Namibia, Niger and Senegal, all wit-
nessed statistically significant improvements in
this indicator, the low starting levels and slow
rates of improvement will keep them from re-
alizing the goal regardless of our assumption
about curvature in the rates of improvement.
In Tables 10 and 11, we present two proxies
for access to reproductive health services.
Given the difficulty of disentangling access
from knowledge and usage, we present esti-
mates of the percentage of women who know
of, and use modern forms of contraceptives. As
described in the methodology section, these
percentages are calculated over the population
of women who ‘‘need’’ access (i.e., fecund,
nonmenopausal and not desiring to currently
have children), not over all women. Our find-
ings show that in both urban and rural areas in
every African country for which we have data
(except Madagascar, which nevertheless has
seen statistically significant improvements in
rural and national levels), knowledge of mod-
ern contraceptives has been increasing at linear
rates in excess of the target path that would
result in the goal of 100% access being realized.
The rapid increases in rural Mali, and to a
lesser extent rural Nigeria, are particularly
pronounced.
In contrast, there is no case in either urban or
rural areas, where the percentage of women
using modern methods of contraception in-
creases at a rate that even comes close to fol-
lowing the target path (Table 11). Aside from
Kenya and Zimbabwe, in none of the African
countries for which we have data do we find
more than 10% of rural women using modern
contraceptive devices in the first survey period.
The picture is not much rosier in urban areas.
While nearly two-thirds of the women in urban
Zimbabwe use such contraception, the next
highest figure is 35% from urban Kenya. In no
other country did more than one-quarter of the
urban women use modern contraceptives in the
first survey period. Thus, while this is consistent
with the general picture of higher living stan-
dards in urban relative to rural areas that we
observe for other indicators, use of modern
contraceptives remains low in rural and urban
areas alike.
Despite this sobering assessment of the bleak
prospects for realizing the goal of access to
modern contraception, we find statistically
significant improvements in all cases except
urban Madagascar and urban Zimbabwe. The
fact that these improvements have occurred
despite the poor performance relative to targets
reflects the ambitious nature of the target to
ensure universal access, especially given the low
starting levels. This situation contrasts with the
previous indicator of knowledge of modern
contraception. For example, in Burkina Faso,
only 2.4% of the women in rural areas reported
using modern contraception at the base period
for which we have data (1992), while just
over 60% indicated they were knowledgeable
of modern contraceptive methods. This is an
enormous difference that may reflect largely the
inaccessibility of services, but may be a result of
other socio-cultural factors as well. From the
perspective of our target analysis, the slope of
the target path is thus far steeper for every
country when it comes to realizing universal
use of modern contraception than universal
knowledge. In other words, far greater absolute
changes in use than knowledge are necessary to
meet these goals. This being said, we find in
Tables 10 and 11 that, except for Kenya, the
absolute increases in the percentage of women
with knowledge of modern contraception ex-
ceeds the absolute increases in the percentage of
 MILLENNIUM DEVELOPMENT GOALS IN AFRICA 43

Table 10. Percentage of women who know of modern contraceptive methodsa

Country First Second t-Statistic for 1990 2015 Projections On target?
(DHS years) survey year survey year difference (%)
Linear Log-linear Target Linear Log-
(%) (%)
(%) (%) (%) linear
Burkina Faso (1992, 1999)
National 67.2 80.2 11.6 63.5 100 92.5 100 Y N
Urban 95.0 98.5 4.5 94.0 100 100 100 Y Y
Rural 60.7 76.7 11.0 56.1 100 92.1 100 Y N
Cameroon (1991, 1998)
National 69.9 84.5 9.4 67.8 100 99.1 100 Y N
Urban 81.3 95.5 8.4 79.3 100 100 100 Y Y
Rural 62.3 77.7 6.2 60.2 100 93.0 100 Y N
Ghana (1993, 1998)
National 77.9 93.8 15.3 81.1 100 100 100 Y Y
Urban 87.7 97.4 6.8 89.7 100 100 100 Y Y
Rural 73.3 91.9 13.7 77.0 100 100 100 Y Y
Kenya (1993, 1998)
National 92.0 98.3 12.5 93.2 100 100 100 Y Y
Urban 96.4 98.8 3.1 96.9 100 100 100 Y Y
Rural 91.2 98.1 11.6 92.6 100 100 100 Y Y
Madagascar (1992, 1997)
National 67.4 73.8 5.2 64.8 96.9 83.2 100 N N
Urban 91.4 89.9 )1.2 92.1 84.4 87.7 100 N N
Rural 61.5 67.6 3.8 59.0 89.7 76.6 100 N N
Mali (1987, 1995)
National 26.3 69.0 30.6 42.3 100 100 100 Y Y
Urban 55.1 89.5 15.4 68.0 100 100 100 Y Y
Rural 15.9 60.2 27.6 32.5 100 100 100 Y Y
Niger (1992, 1997)
National 61.8 77.5 12.7 55.5 100 100 100 Y Y
Urban 92.3 98.1 6.0 90.0 100 100 100 Y Y
Rural 55.8 72.0 10.0 49.4 100 95.7 100 Y N
Nigeria (1990, 1999)
National 44.9 69.9 20.8 44.9 100 88.3 100 Y N
Urban 73.1 87.1 8.6 73.3 100 97.4 100 Y N
Rural 36.5 61.8 16.8 36.5 100 80.5 100 Y N
Senegal (1986, 1992, 1997)
National 73.8 85.7 8.8 78.1 100 93.6 100 Y N
Urban 89.8 96.9 4.9 92.4 100 100 100 Y Y
Rural 63.9 78.8 7.9 69.3 100 88.7 100 Y N
Tanzania (1991, 1996, 1999)
National 81.4 90.7 10.1 80.2 100 98.4 100 Y N
Urban 93.4 97.1 3.1 93.0 100 100 100 Y Y
Rural 77.7 88.1 8.8 76.4 100 96.8 100 Y N
Togo (1988, 1998)
National 83.2 95.5 12.2 85.6 100 100 100 Y Y
Urban 93.9 98.5 3.9 94.8 100 100 100 Y Y
Rural 78.8 93.8 11.3 81.8 100 100 100 Y Y
Uganda (1988, 1995)
National 79.1 91.7 10.4 82.7 100 100 100 Y Y
Urban 93.4 95.5 1.2 94.0 100 97.8 100 Y N
Rural 77.5 90.9 9.6 81.3 100 100 100 Y Y
(Continued on next page)
44 WORLD DEVELOPMENT

Table 10—continued
Country First Second t-Statistic for 1990 2015 Projections On target?
(DHS years) survey year survey year difference (%)
Linear Log-linear Target Linear Log-
(%) (%)
(%) (%) (%) linear
Zambia (1992, 1996)
National 92.8 97.9 8.7 90.2 100 100 100 Y Y
Urban 97.3 98.8 2.6 96.5 100 100 100 Y Y
Rural 87.9 97.2 9.0 83.3 100 100 100 Y Y
Zimbabwe (1988, 1994)
National 98.5 98.9 1.3 98.6 100 99.5 100 Y N
Urban 99.4 99.6 0.5 99.5 100 99.9 100 Y N
Rural 98.1 98.6 1.2 98.2 100 99.4 100 Y N

Indicates significance at the 10% level.

Indicates significance at the 1% level.

Indicates significance at the 5% level.
a
Women who need access to reproductive health services (i.e., those not seeking to get pregnant).

women using modern methods, despite the base
level for the latter being far lower. In urban
areas, this is also the case for Cameroon,
Ghana, Mali and Nigeria. In Madagascar,
both use and knowledge fell as a percentage of
urban women in need of reproductive health
services. In those urban areas where the abso-
lute percentage increase in knowledge of mod-
ern contraceptives was less than the increase in
usage, the initial percentages of women with
knowledge of modern methods were 90% or
higher, thus there is little room for improve-
ment.
In Table 12 we summarize the results of our
target analysis, by country for rural, urban and
national levels. The first set of columns shows,
when using linear projections, the number of
indicators that are on target to achieve the de-
velopment goals as stated in the MDG (and the
added goal of reducing malnutrition by two-
thirds) for each country. Note that we have
data on five or more goals for 12 countries. 23
Among these countries, in rural areas for
Burkina Faso, Mali, and Niger, changes al-
ready observed in the data suggest that none of
the MDG will be met. To make matters worse,
in Nigeria and Zambia, this also holds true in
urban areas. In rural areas, Ghana and Mad-
agascar are the only two countries to be on
target to achieve two of the seven goals. Ad-
mittedly, we have information on the realiza-
tion of only two goals in nine countries.
Nonetheless, it is only in rural areas in these
latter countries where we find that at most half
of the goals are likely to be met. In some cases,
though not all, urban areas are faring better
than rural areas in terms of their potential for
reaching the targets. 24 For example, in urban
Ghana and Tanzania, three of the seven targets
are likely to be achieved, with two of them
being reductions in poverty and malnutrition.
In Senegal and Mali, where we only have
measurements on five of the seven goals,
three of the targets are likely to be reached
in the urban areas (again with a commonality
of declines in poverty). Nonetheless, in the
majority of the cases, the MDG are unlikely
to be met in urban, just as in rural, areas in
Africa.
A somewhat more optimistic assessment of
progress toward realizing improvements in liv-
ing standards is found in the last three columns
of Table 12, which simply address whether
there are statistically significant improvements
for the indicators, regardless of whether the
rates of improvement are rapid enough to reach
the MDG. At a national level, Ghana, Mada-
gascar and Niger have witnessed improvements
in five out of seven indicators. A number of
countries, particularly Senegal, Togo, and
Uganda also do well in terms of the share of
indicators for which improvements are noted.
In contrast, Burkina Faso, Zambia and Zim-
babwe only see improvements in one out of
seven goals. In rural and urban areas, Ghana
and Niger are also the best performers of those
countries where we have data on all the goals,
but again, Senegal, Togo and Uganda do well
in both urban and rural areas, as does Mali in
urban areas.
 MILLENNIUM DEVELOPMENT GOALS IN AFRICA 45

Table 11. Percentage of women who use modern contraceptive methodsa

Country First Second t-Statistic for 1990 2015 Projections On target?
(DHS years) survey year survey year difference (%)
Linear Log-linear Target Linear Log-linear
(%) (%)
(%) (%) (%)
Burkina Faso (1992, 1999)
National 6.2 8.1 2.9 5.7 12.4 9.9 100 N N
Urban 22.5 30.4 3.9 20.2 48.5 37.9 100 N N
Rural 2.4 3.9 2.8 2.0 7.4 5.4 100 N N
Cameroon (1991, 1998)
National 8.4 14.4 5.4 7.5 28.9 20.3 100 N N
Urban 13.0 21.6 4.7 11.8 42.3 30.1 100 N N
Rural 5.3 9.9 3.4 4.6 20.9 14.4 100 N N
Ghana (1993, 1998)
National 7.3 15.1 8.7 8.9 28.4 20.6 100 N N
Urban 11.1 18.2 3.9 12.5 30.1 28.0 100 N N
Rural 5.5 13.5 8.0 7.1 27.0 19.1 100 N N
Kenya (1993, 1998)
National 23.5 36.7 13.0 26.1 59.0 45.9 100 N N
Urban 34.6 46.5 4.9 37.0 66.8 54.9 100 N N
Rural 21.6 33.6 10.8 24.0 54.1 42.1 100 N N
Madagascar (1992, 1997)
National 8.1 12.3 5.2 6.5 27.2 18.4 100 N N
Urban 21.8 20.1 )0.9 22.5 13.9 17.6 100 N N
Rural 4.8 9.3 5.5 3.0 25.5 15.9 100 N N
Mali (1987, 1995)
National 1.7 7.7 11.3 4.0 22.9 13.7 100 N N
Urban 5.9 18.9 9.0 10.8 51.2 31.7 100 N N
Rural 0.2 3.0 8.1 1.2 10.1 5.8 100 N N
Niger (1992, 1997)
National 4.2 8.5 6.6 2.5 23.9 14.8 100 N N
Urban 17.7 26.7 4.8 14.1 59.0 39.8 100 N N
Rural 1.5 3.6 3.9 0.7 11.0 6.6 100 N N
Nigeria (1990, 1999)
National 5.8 15.6 12.6 5.8 32.9 22.8 100 N N
Urban 14.7 23.7 5.4 14.7 39.8 30.4 100 N N
Rural 3.2 11.8 10.5 3.2 27.0 18.1 100 N N
Senegal (1986, 1992, 1997)
National 5.2 11.7 7.9 7.6 22.3 16.0 100 N N
Urban 12.6 25.4 6.4 17.2 46.3 33.9 100 N N
Rural 0.6 3.3 5.9 1.6 7.7 5.1 100 N N
Tanzania (1991, 1996, 1999)
National 10.6 21.9 10.9 9.2 44.5 31.3 100 N N
Urban 20.9 38.9 7.5 18.6 75.1 54.0 100 N N
Rural 7.5 15.1 7.1 6.5 30.2 21.4 100 N N
Togo (1988, 1998)
National 4.2 11.7 10.8 5.7 24.6 17.0 100 N N
Urban 9.1 18.0 5.3 10.9 33.1 24.2 100 N N
Rural 2.2 8.3 9.0 3.4 18.6 12.5 100 N N
Uganda (1988, 1995)
National 5.3 11.3 7.5 7.0 28.2 18.0 100 N N
Urban 22.3 29.1 2.3 24.3 48.6 36.9 100 N N
Rural 3.4 7.6 5.4 4.6 19.6 12.4 100 N N
(Continued on next page)
46 WORLD DEVELOPMENT

Table 11—continued
Country First Second t-Statistic for 1990 2015 Projections On target?
(DHS years) survey year survey year difference (%)
Linear Log-linear Target Linear Log-linear
(%) (%)
(%) (%) (%)
Zambia (1992, 1996)
National 15.2 19.1 3.9 13.3 37.8 26.6 100 N N
Urban 24.6 27.6 1.7 23.1 41.9 33.3 100 N N
Rural 5.2 11.3 6.5 2.2 40.2 22.9 100 N N
Zimbabwe (1988, 1994)
National 50.3 53.8 2.3 51.5 66.1 58.6 100 N N
Urban 65.6 65.2 )0.2 65.5 63.8 64.7 100 N N
Rural 43.4 48.5 2.8 45.1 66.4 55.5 100 N N
*
Indicates significance at the 10% level.
**
Indicates significance at the 1% level.
***
Indicates significance at the 5% level.
a
Women who need access to reproductive health services (i.e., those not seeking to get pregnant).

Table 12. Progress among indicators of well-being

Number of Number of IDGs on target Number of indicators for which
indicators in to be achieved there is statistically significant
the data improvement
National Urban Rural National Urban Rural
1 Benin (1996) 2 1 0 1 0 0 0
2 Burkina Faso (1992, 1999) 7 0 2 0 1 3 1
3 Burundi (1987) 2 1 0 1 0 0 0
4 Cameroon (1991, 1998) 6 0 2 0 3 3 3
5 Central African Republic (1994) 2 0 0 0 1 0 1
6 Chad (1997) 2 1 0 1 1 0 1
7 Comoros (1996) 2 1 0 1 0 0 0
8 C^
ote dÕIvoire (1994) 2 1 1 1 1 0 1
9 Ghana (1988, 1993, 1998) 7 3 3 2 5 4 5
10 Kenya (1988, 1993, 1998) 7 1 2 1 3 2 3
11 Madagascar (1992, 1997) 7 1 0 2 5 1 5
12 Malawi (1992) 2 0 1 0 0 0 0
13 Mali (1987, 1995) 5 0 3 0 4 4 4
14 Mozambique (1997) 2 1 1 1 0 1 0
15 Namibia (1992) 2 1 2 1 1 0 1
16 Niger (1992, 1997) 7 1 1 0 5 5 5
17 Nigeria (1990, 1999) 7 0 0 0 4 2 4
18 Rwanda (1992) 2 1 0 1 0 0 0
19 Senegal (1986, 1992, 1997) 5 1 3 0 4 4 4
20 Tanzania (1991, 1996, 1999) 7 2 3 1 4 5 4
21 Togo (1988, 1998) 3 1 2 1 3 3 3
22 Uganda (1988, 1995) 4 1 1 1 3 2 3
23 Zambia (1992, 1996) 7 0 0 0 1 1 1
24 Zimbabwe (1988, 1994, 1999) 7 0 2 0 1 0 1

5. CONCLUSIONS picture. Despite some noteworthy progress in

In this paper we have quantitatively exam-
ined progress toward the MDG among African
countries, in addition to making statistical
comparisons of changes in living standards
over time. The results paint a discouraging
improved living standards in certain dimen-
sions in a select number of countries, the pre-
ponderance of the evidence suggests that, in the
absence of dramatic changes, the MDG are not
going to be reached for most indicators in most
countries. In the case of our poverty estimates,
 MILLENNIUM DEVELOPMENT GOALS IN AFRICA
only two of 11 rural populations exhibit pro-
gress commensurate with the linear target path;
although, in five countries, the urban sectors
are on target. With regard to enrollments, only
Kenya and urban Cameroon are on target.
Things would even be worse if we assume that
the paths of improvement over time take on
log-linear shapes.
Only three of the 10 countries for which we
have data on changes in education have wit-
nessed reductions in gender discrimination in
urban areas consistent with the target. What is
worse is that this is only the case for rural areas
in two countries. Not a single country out of 24
is on target in terms of increasing births at-
tended by skilled personnel in rural areas, and
only four are on target in urban areas. The
HIV/AIDS epidemic, in fact, will likely make
attended births all the more important, espe-
cially to the extent that mid-wives and other
health care workers have access to pharma-
ceuticals to reduce the probability of mother to
child transmission. Likewise, other harmful
consequences of the failure to progress in this
area include jeopardizing the health of women
during delivery, increasing the chances of neo-
natal deaths, and losing the opportunity for
birth attendants to educate women in areas
such as proper child lactation and weaning
practices, and child spacing technologies.
Togo is the only country of the 14 for which
we have anthropometric data over time where
the target for reducing rural malnutrition seems
realizable. Things are slightly better in urban
areas, where Ghana and Tanzania are also on
target. These stunting results are robust to our
assumptions about whether rates of change
assume a linear or log-linear path through
2015. In terms of universal access to modern
reproductive health services, not one country is
on track vis-a-vis use of modern contraceptives.
In most countries, however, knowledge of
modern contraceptive methods is likely to be
universal by 2015 provided that the trends
continue linearly. If, however, we assume that
the trajectories are log-linear, things do not
look nearly so favorable in rural areas. Fortu-
nately, all this bad news is slightly tempered by
the trends in infant mortality. The results of
our analysis suggest that in 10 (six) of 24
countries, mortality targets will be realized in
rural (urban) areas if improvements persist
linearly.
More encouraging is our analysis of im-
provements in living standards in general, re-
gardless of whether the progress is sufficient to
47
realize the MDG. For many indicators, we
observe statistically significant improvements in
many, if not all the countries, even when the
current rates of change will leave the targets
unmet by 2015. For example, no country is on
target to realize the goals regarding modern
contraception, but all have made progress over
the periods for which we have data. Most
countries have reduced poverty, but few are on
target to halve poverty by 2015. More than half
the countries have increased enrollments, but
only one is on target to reach the goal of uni-
versal enrollment. Finally, although only one
country is on target to reduce malnutrition by
two-thirds, four of 14 countries have reduced
levels of stunting in the 1990s. So, while this is
welcome news, legitimate concerns remain
about the pace of progress. Quite simply, sta-
tistically significant improvement is just that,
and says little about the rate of change.
While our findings are particularly informa-
tive with regard to assessing the progress of
countries toward achieving the MDG, it is im-
portant to keep in mind that in most cases, we
rely on only two survey time periods from
which we can estimate trends. Further, these
cover only a relatively brief span of time. As
more DHS surveys come on line, it will be
important to update our analysis in order to
extend the period of coverage. Nonetheless,
despite the major pitfall of our work––that the
time periods for which we can measure change
are often brief (with the exception of the mor-
tality statistics)––we argue that the information
on intertemporal trends based on only two
DHS surveys is far more accurate and mean-
ingful than similar two points in time compar-
isons for, say, changes in income and/or
expenditures. This follows because, first, survey
and sampling methods do not change for the
DHS surveys we employ. Second, we need not
worry about problems of deflators, purchasing
power parity, and other market price related
issues that plague money-metric welfare mea-
sures. Third, for some indicators such as infant
mortality and attended births, we can construct
long-term data series from retrospective infor-
mation. Fourth, for most other indicators,
there are unlikely to be significant transient or
short-term intertemporal fluctuations. For ex-
ample, contraceptive knowledge and chronic
malnutrition (the cumulative effect of well-be-
ing over the past few years) will not change
markedly in response to the types of shocks
that may affect incomes. Thus, our trends
are based not on two unstable snapshots of
48 WORLD DEVELOPMENT
well-being, but rather on measures the stock of
well-being at the time of the surveys. We believe
that these stocks are not terribly sensitive to
short-term exogenous shocks. This being said,
we still need to emphasize that for some indi-
cators, particularly mortality, the notion of
linear progress and its pace are conditioned by
the ravages of HIV/AIDS and other unforeseen
positive and negative health shocks. Thus,
while we compare log-linear and linear projec-
tions to goals, the true shape of path of pro-
gress is unknown. Are there increasing returns
to investing in health and education infra-
structure? Is it reasonable to expect the pace in
declining mortality to accelerate or decelerate
in most countries? Will diseases such as tuber-
culosis continue their resurgence (WHO, 2001)?
Will the prevalence of other diseases such as
malaria continue to fluctuate (WHO, 1999)?
We do not claim to have satisfactory answers to
these questions.
Ultimately, regardless of the assumptions we
make in our analysis, the poor performance in
terms of improving living standards in Africa
seems irrefutable. In fact, if we consider that
the worst-off countries in sub-Saharan Africa
(i.e., those torn apart by war and communal
violence) are not represented in the survey data
analysis, things overall are undoubtedly worse
than portrayed here. The results are particu-
NOTES
1. For example, in the most authoritative report on the
topic thus far (IMF et al., 2000), we find that the
‘‘statistics. . . were provided by various international
agencies, which compiled or estimated them on the basis
of reports from national authorities. They are the best
available today. But the picture they portray is flawed
because for some countries the data are incomplete,
unreliable or unavailable.’’
2. Sahn, Stifel, and Younger (2002) discuss in more
detail levels and trends in urban–rural disparities.
3. There are also other household budget surveys
conducted by governments and research institutions
that share many of the characteristics and offer many of
the same possibilities for analysis as the LSMS.
4. These studies used income and expenditure data for
Ethiopia (Dercon, 2000, 2001), Ghana (Coulombe &
McKay, 2001), Madagascar (Razafindravonona, Stifel,
& Paternostro, 2001), Mauritania (McCulloch, Baulch,
larly sobering for rural areas, where living
standards are universally lower, and where
rates of progress generally lag behind urban
areas. In the final analysis, the targets against
which we compare progress are the outcome
of political consultations among international
organizations and member countries of the
United Nations. Even if they were adjusted to
be somewhat less ambitious, the basic results of
our analysis would not change. Rather, given
the rate of progress, of which there has been
some, quite substantial revisions in the MDG
will likely be necessary to avoid widespread
failure to achieve targets across the continent.
This being said, we do not address perhaps the
fundamental issue: how policy can be re-shaped
to accelerate progress toward the MDG. The
paramount importance of sustainable pro-poor
growth, and the strategic pillars necessary to
achieve it have been widely debated and artic-
ulated. As such, an assessment of these policies
is beyond the scope of this paper. Nonetheless,
because the targets are out there and are widely
disseminated and used by governments and the
international agencies, an assessment of pro-
gress toward them and expectations about them
is extremely important. This paper is one such
reality check, with results that are not terribly
encouraging for those concerned about raising
living standards in Africa.
& Cherel-Robson, 2000b), Uganda (Appleton, Emwanu,
Kagugube, & Muwonge, 1999), Zambia (McCulloch,
Baulch, & Cherel-Robson, 2000a), and Zimbabwe
(Alwang & Ersado, 1999; Alwang, 2000; Alwang, Mills,
& Taruvinga, 1999, 2002; Burger, Hoogeveen, Kinsey, &
Sparrow, 2000).
5. Chen and Ravallion (2001) have estimated dollar/
day poverty lines for many African countries. But, this
effort often involves strong assumptions and reliance on
purchasing power parity exchange rates which are often
not precise. Furthermore, these efforts, unlike in the
intertemporal comparisons within a country, have not
effectively dealt with differences in survey instruments
and methods.
6. The DHS is a project funded primarily by USAID,
and is administered by Macro International Inc.
7. See Sahn and Stifel (2000) for a detailed discussion
of this asset index and how it is constructed.
 MILLENNIUM DEVELOPMENT GOALS IN AFRICA
8. Ideally, the weights should be allowed to vary over
time. For obvious practical reasons (i.e., estimating
weights separately for each survey year results in the
same mean asset index value for each distribution), the
weights must be estimated from the pooled sample to
make poverty comparisons. In initial experiments,
weights estimated separately across time within coun-
tries did not differ substantially. The results that follow
are thus insensitive to pooling the samples within
countries to estimate the index weights.
9. We could have arbitrarily chosen some percentile of
the first survey year as the poverty line with which to
analyze trends in relative poverty. We opted, however,
to employ the $/day poverty estimates to make the
choice of the poverty line less arbitrary.
10. In the case of Ghana, Kenya, Senegal and Tanza-
nia where we have three surveys, we iteratively estimate
linear regression lines through the three poverty rates.
11. This information was not available in the first
round of the DHS.
12. Because of the retrospective nature of the data, we
do not need more than one survey to estimate changes in
IMR. Thus we have indicators of changes in IMR for all
24 countries in sub-Saharan Africa for which DHS data
are available.
13. Sahn et al. (1999) find remarkably close IMR point
estimates within countries where there exist more than
one survey and where there is overlap among the yearly
estimates. This suggests that the quality of these recall
data are very good.
14. As with the mortality data, only one survey is
necessary to estimate changes in the quality of neonatal
care because of the retrospective nature of the maternity
data.
15. A variety of other anthropometric indicators,
particularly weight-for-height and weight-for-age are
used in the nutrition literature. The former is an
indicator of short-term malnutrition and poor health.
It is more stochastic in nature reflecting recent acute
negative shocks. The latter is a composite of height-for-
age and weight-for-height, and is thus more difficult to
interpret. Disentangling the respective contributions of
recent acute, chronic health and nutrition problems can
be problematic when using this measure. In measuring
the general health status of children, height-for-age is the
preferred indicator (WHO, 1995; Strauss & Thomas,
1995).
49
16. Since the z-score for the reference population has a
standard normal distribution in the limit, any given child
has a probability distribution on the expected value of
his/her z-score. As such, if more than 2.5% of a
population of children has a z-score that falls two
standard deviations below zero, then there is said to be
malnutrition in the country. We follow the standard
practice of not subtracting this 2.5% (i.e., the share of
the population expected to have z-scores less than
2),
and note that this does not affect the estimated changes
in malnutrition.
17. In addition to the standard set of survey instru-
ments, country-specific questions are asked.
18. Note that this also affects Ghana, Kenya and
Zimbabwe. But since each of these countries has three
surveys, two of which were in the second or third wave
when information on educational status and attainment
was included in the household roster, changes in
enrollments can be estimated. Although Senegal has
two later wave surveys, information on education is not
available in the 1992 data.
19. Technically, we reject the null hypothesis that the
distributions of asset indices over time for these coun-
tries are the same. Ravallion (1996) and Foster and
Shorrocks (1988) provide the interpretation that reject-
ing the null hypothesis is equivalent to concluding that
poverty levels are different in the same direction (i.e.,
more poverty in one year than another) for any given
poverty line and any given poverty measure.
20. The relative changes in rural and urban poverty for
Ghana, Kenya and Zambia are consistent with those
Eastwood and Lipton (2000) report using non-DHS
evidence. For further analysis of urban–rural disparities
using the DHS data (see Sahn et al., 2002).
21. Note that where the projections exceed 100––and
inevitability at some point when using linear projec-
tions––we truncate the estimate to 100.
22. To be more precise, the log linear projections take
the form y ¼ a þ b lnðtÞ, where y is the IMR in this case,
and t is the time trend.
23. These countries comprise 46.3% of sub-Saharan
AfricaÕs population (World Bank, 2001b).
24. Note that greater improvement in rural areas than
in urban areas does not imply that the levels of welfare in
the former will be any higher than in the latter.
50 WORLD DEVELOPMENT
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APPENDIX
Consider two distributions of welfare indi-
cators with cumulative distribution functions,
FA and FB , with support in the nonnegative real
numbers. Let
Z x
D1A ðxÞ ¼ FA ðxÞ ¼ dFA ðyÞ:
0 ‘‘poverty deficit’’ curves (D2 ) cross, then higher
If D1A ðxÞ 6 ð<Þ D1B ðxÞ
for all x 2 Rþ (i.e., FA is
everywhere to the right of FB ), then distribution
A is said to (strictly) first-order dominate dis-
tribution B. In terms of welfare economics, the
interpretation is that up to the poverty line x, A
is a better distribution than B for any welfare
function that is both increasing in the welfare
variable (e.g., expenditures or height-for-age)
and anonymous, in the sense that we do not
care that one particular personÕs welfare falls,
as long as anotherÕs rises by more than enough
to compensate. If we can say this for a broad
range of poverty lines, then we have a quite
general conclusion that A is preferable to B.
Both the anthropometric z-scores and the asset
index have negative values. But this does not
cause a problem because the distributions of
these welfare indicators can be shifted upward
so that the support is entirely positive without
affecting the outcome of the tests.
Since D1A ðxÞ is also the poverty headcount
ratio (P0 ) where the x is the poverty line, it
follows that first-order dominance implies that
poverty as measured by P0 is lower for distri-
bution A than for distribution B regardless of
the poverty line chosen. Dominance results can
also be considered up to a maximum allowable
poverty line if we are not concerned with rela-
tive changes in the upper ends of the distribu-
tion.
If the two distributions cross within the range
of poverty lines that we consider relevant, then
first-order dominance does not hold, and we
know that different poverty lines and measures
will rank the distributions differently. In other
words, depending on the poverty line or mea-
51
sure chosen, we might simultaneously conclude
that poverty increased or decreased. In this
case, we can still make a fairly general welfare
statement if second-order dominance holds. In
particular, if A second-order dominates B, then
A is a better distribution than B for all welfare
functions that are increasing, anonymous, and
that favor equality. To define second-order
dominance, let D2A ðxÞ be the area under FA up to
x,
Z x
D2A ðxÞ ¼ D1A ðyÞ dy:
0
If D2A ðxÞ 6 ð<Þ D2B ðxÞ for all x (i.e., the area
under FA up to x is less the area under FB up to
x), then distribution A is said to (strictly) sec-
ond-order dominate distribution B.
If, to use RavallionÕs (1996) terminology, the
orders of dominance can be checked. To gen-
eralize, let
Z x
DsA ðxÞ ¼ Ds
1
A ðyÞ dy;
0
for any integer, s P 2. Now distribution A is
said to (strictly) dominate distribution B at
order s if DsA ðxÞ 6 ð<Þ DsB ðxÞ.
Davidson and Duclos (2000) show that Ds ðxÞ
can be equivalently expressed as
Z x
1
Ds ðxÞ ¼ ðx
yÞs
1 dF ðyÞ:
ðs
1Þ! 0
This formulation makes it easy to see that
second-order dominance implies that the pov-
erty gap (P1 ) is less for distribution A than for
distribution B for all possible poverty lines.
Further, third-order dominance implies an un-
ambiguous change in the squared poverty gap
(P2 ). To generalize even further, welfare domi-
nance of order s implies that the Foster–Greer–
Thorbecke poverty measure Ps
1 is less for
distribution A than for distribution B for all
possible poverty lines. Foster and Shorrocks
(1988) show that while first-order dominance is
a sufficient condition for higher-order domi-
nance, it is not a necessary condition. Thus if
we find that a distribution first-order dominates
another, then we know how poverty as mea-
sured by any of the FGT Pa measures has
changed over the relevant range of poverty
lines.
Davidson and Duclos (2000) also show that
if we have a random sample of N independent
observations on the welfare variable, yi , from a
population, then a natural estimator of Ds ðxÞ is
52
Z x
b s ðxÞ ¼ 1 For the height for age nutrition indicators,
D ðx
yÞs
1 d Fb ðyÞ
ðs
1Þ! 0
1 XN
¼ ðx
yi Þs
1 Iðyi 6 xÞ;
N ðs
1Þ! i¼1
where Fb is the empirical cumulative distribu-
tion function of the sample, and Ið Þ is an in-
dicator function, which is equal to one when itÕs
argument is true, and equal to zero when false.
We apply this estimator to two independent
samples for each of our indicators. Thus,
varð D b s ðxÞÞ ¼ varð D
b s ðxÞ
D b s ðxÞÞ þ varð D
b s ðxÞÞ;
A B A B
which is easy to estimate since D b s ðxÞ is a sum of
iid variables. Simple t-statistics are constructed
to test the null hypothesis,
b s ðxÞ
D
H0 : D b s ðxÞ ¼ 0;
A B
for a series of test points up to an arbitrarily
defined highest reasonable poverty line. In
cases where the null hypothesis is rejected and
the signs are the same on all of the t-statistics,
then dominance of order s is declared. The tests
were conducted up to s ¼ 3, after which ‘‘no
dominance’’ is declared. Foster and Shorrocks
(1988) show that eventually one distribution
will dominate the other at a higher order. But it
is difficult to interpret orders of dominance
greater than two, much less three.
WORLD DEVELOPMENT
stochastic dominance tests were applied to the
distributions of z-scores up to values of
1 (one
standard deviations below the mean of the
reference population, respectively). This is ap-
propriate because we are primarily interested in
changes in malnutrition, and because a right-
ward shift in the entire distribution of z-score
cannot be interpreted in the same manner as a
similar shift in the distribution of expenditures
or income.
Since the cumulative distribution functions
are defined over supports in the nonnegative
real numbers, and because shifting all of the
distributions of nutrition indicators by the
same constant does not change any of the in-
formation, we added values of 10 to each z-
score to conduct the tests. Note that since Ds ðxÞ
is not normalized by the ‘‘poverty line’’ (x) (i.e.,
the magnitude of the ‘‘poverty gap’’ (x
y) is
all that matters in the estimate of Ds ðxÞ, and
varðDs ðxÞÞ), shifts in both the indicator and the
maximum poverty line do not affect the out-
come of the tests.
We also apply stochastic dominance tests to
the shifted distributions of household asset in-
dexes up to a relative poverty line defined for a
given country by the 40th percentile of the
distribution in the first survey. Since the
weights are consistent across surveys for a
country, applying this poverty line to the sec-
ond survey is also consistent.