Despite favorable economic indicators, social indicators broken down by geographic areas, gender, ethnic groups and economic quintiles show that families in the highest income quintile earn 24 times more than families in the bottom quintile. Levels of poverty in economic and deprivation remain high especially in some parts of the altiplano (highlands), and in rural areas, with an average incidence of poverty lying at 41 per cent (2012). Children and adolescents from rural indigenous backgrounds are the most affected by poverty.
Despite significant improvements in Bolivia’s maternal and child health indicators in recent years, the indicators remain among the worst in the region. Neonatal deaths are responsible for most infant mortalities and respiratory and diarrhoeal infections are the principal causes of preventable childhood illnesses and deaths. In terms of maternal mortality, according to the most recent data recognized by the government, which is from 2003, the ratio was 229 maternal deaths per 100,000 live births. 2012 Census data show that 67 per cent of births were attended in health facilities compared to 53 per cent in 2001. In addition, indigenous women are four times at risk of dying from complications during pregnancy, childbirth or postpartum than women living in cities, 64 per cent and 15 per cent respectively. A significant gap in maternal health exists between Departments where the population is predominantly indigenous.
There have been significant gains in education in recent years, particularly in increasing access to primary education and reducing illiteracy. Most notably primary school net enrolment ratio has reached 82 per cent with no gender difference. However, important disparities between population groups remain: a boy in an urban area belonging to the highest income quintile completes, on average, 15.8 years of schooling, whereas a girl in a rural area belonging to the lowest income quintile achieves only three years of schooling.
Bolivia has made significant progress in increasing water and sanitation coverage. However, the country is behind schedule with regard to sanitation indicators. In rural areas, 72 per cent of the population use improved water points and only 32 per cent have access to improved sanitation systems. In addition, many challenges are faced by girls in schools as their menstruation begins. There is a lack of appropriate information, support and materials to manage hygiene during menstruation and to the poor state of the WASH facilities in most educational establishments increase the stress and difficulties faced by girls to attend, concentrate on, and participate actively in, school.
Adolescent pregnancy is a major challenge, threatening the lives and wellbeing of both mothers and their babies. Currently in Latin America and the Caribbean, one out of three girls becomes a mother before the age of 20. According to the World Health Organization the risk of maternal death is four times higher among girls under 16 years than among women in their 20s. Moreover, infants of teenage mothers and/ or mothers with low education are 3.5 times more likely to die according to Bolivia’s 2008 National Demographic Health Survey. The percentage of adolescent pregnancies in Pando is twice the national average and is 4.7 times greater than for adolescent girls in the richest quintile.
The most recent data on domestic violence indicates that as many as 53 per cent of female adolescents and youth who were married or in some kind of union were victims of violence by their partner and 60 per cent of students, including girls were victims of violence perpetrated by their teachers.