The Center for Economic and Social Rights carries out research and advocacy projects on economic, social and cultural rights in countries around the globe, in collaboration with local human rights advocates and activists. This report analyzes the current situation in Madagascar.

1. Madagascar
C E S R
center for Economic and social rights fact sheet no. 6
In light of Madagascar’s appearance before the committee on Economic, social and
cultural rights in May 2009 and the forthcoming possible mission of the UN special
rapporteur on the right to Food to Madagascar, this fact sheet looks at the realization
of the right to an adequate standard of living in Madagascar. It focuses on the rights to
food, health and water and possible policy failures in these areas, with the aim of graph-
ically illustrating background information to help assess compliance of the government
of Madagascar with the International covenant on Economic, social and cultural rights.
This factsheet highlights some of the 2003 concluding observations on Madagascar by
the committee on the rights of the child.
Food security in Madagascar is precarious. The large majority of Madagascar’s peo-
ple live in rural areas, with only 27 percent of the country’s population living in cities and
towns (EIU 2007). Most people survive as small farmers, producing for their own con-
sumption (FaO 2008). But they are vulnerable to food insecurity as a result of frequent
natural disasters, undiversified production and lack of access to basic infrastructure.
The prevalence of undernourishment in Madagascar is higher now than it was in 1992
and is much higher than the sub-saharan african average (World Bank 2008). Levels of
acute child malnutrition have risen in recent years, as have levels of income inequality,
despite an overall increase in national gdP wealth. Within the country, child malnutri-
tion is widespread, but varies by up to 10 percent across different regions.
as this factsheet illustrates, access to improved water sources and sanitation also
varies drastically by region. almost 70 percent of those in the country’s capital have
access to an improved water source, while less than a quarter of people have such
access in the province of Toamasina. The Malagasy people face low and unequal access
to safe water, sanitation and health treatment, with high child mortality rates. Yet Mad-
agascar spends the lowest proportion of its budget on health, as a percentage of its gdP,
compared to its southern african neighbors. Its tax base is also comparatively low and
its regressive tax regime could affect its ability to realize the right to an adequate stan-
dard of living for its people. This suggests possible failures of the government to give
priority to the progressive realization of economic, social and cultural rights according
to maximum available resources.
The graphics that follow compare data that derive from the 1992 household survey
and the most recent demographic household survey from 2003/2004. In the absence of
more recent data, this factsheet does not reflect the outcomes of any changes in policy
that may have been instituted since the sweeping gains won by the current president,
Mr. Marc ravalomanana of Tiako-I-Madagasikara (TIM), in national and municipal
elections in 2006 and 2007. It should also be noted that in 2007, voters approved a ref-
erendum to abolish the six autonomous provinces of Madagascar (see disaggregated
data) which will be implemented by 2009.
Visualizing
Rights

2. C E S RMadagascar fact sheet no. 6
2
Madagascar has one of the highest
levels of undernourishment
in Sub-Saharan Africa
at least 38 percent of Madagascar’s population is
undernourished, much higher than the sub-saha-
ran african average (30 percent) and also higher
than the average for low-income countries. The
prevalence of undernourishment among the Mala-
gasy people is higher now than in 1992, raising seri-
ous concerns about the priority the government
has been giving to its commitments to realize the
right to adequate food.
Over half of Malagasy children
are chronically malnourished
Over half of Madagascar’s children are stunted
for their age and over one-third are underweight
(both measures of chronic malnutrition). This is
also much higher than average rates of chronic
malnutrition amongst children in sub-saharan
africa and across low-income countries.
Disparities in the realization of the right
to food persist between Madagascar’s
provinces and between rich and poor.
about half of all children under five living in anta-
nanarivo are stunted, whereas one-third of chil-
dren in antsiranana suffer from stunting. although
there has been national progress in reducing rates
of stunting, from 54 percent in 1992 to 47 percent
in 2003/2004, the prevalence of stunted children
has markedly increased in Mahajanga province.
There are also disparities between rich and poor—
51 percent of children in the poorest 20 percent of
families are stunted, compared with 38 percent of
children from the wealthiest 20 percent (UNdP
2008).
“The Committee is concerned that the sur-
vival and development of children in the
State party continue to be threatened by
early childhood infectious diseases, diar-
rhoea and malnutrition.” (CRC Concluding
Observations 2003)
%ofpopulation,average
25
27
29
31
33
35
37
39
41
1992 1997 2004 Source: World Bank 2008
Sub-Saharan Africa
Madagascar
Low income
29.8
40
38
28.4
29.7
28.9
29.1
35
Figure 1
Undernourishment in Madagascar, Sub-Saharan Africa
and Low-Income Countries (average), 1992–2004
Figure 2
Children Under Height and Underweight for Age, Latest
Available Data
Source: World Bank 2008
55
50
45
40
35
30
25
20
28.9
Malnutrition prevalence,
height for age
(% of children under 5)
52.8
��.� ��.�
36.8
26.8
Malnutrition prevalence,
weight for age
(% of children under 5)
Sub-Saharan Africa
Madagascar
Low-income countries
Figure 3
Percentage of children under-5 stunted, by province,
2003–2004
Source: DHS 2003/2004
Antananarivo: 52.4 percent
Fianarantsoa: 47.8 percent
Mahajanga: 47.6 percent
Toamasina: 47.3 percent
Toliary: 40.5 percent
Antsiranana: 37.1 percent
THE RIGHT TO FOOd

3. center for Economic and social rights
3
Acute malnourishment has risen sharply
amongst Malagasy children
The rate of children under five suffering from
acute malnutrition (under weight for their height
or wasting) has risen markedly since 1992. This
rise began before the political and economic cri-
sis of 2002 and has not improved since, despite
the marked recovery in gdP per capita. The rise in
acute malnutrition raises serious concerns about
the realization of the right to adequate food of
Madagascar’s children.
Figure 5
Percentage of Children Under-5 Wasted (Underweight for
Height), Madagascar and Its Neighbors, Over Time
0
2
4
6
8
10
12
14
Kenya Madagascar Tanzania Uganda Zambia Zimbabwe
Source: DHS Statcompiler
1992/3 1999 2000/1 2003/4 2005/6
Figure 6 South Korea May Lease Half of Madagascar’s Arable Land
Remaining arable land
after South Korean purchase (hectares)
South Korean Daewoo’s
99-year lease of arable land (hectares)
Sources: World Bank 2008, Financial Times 18/11/08
1.65 million hectares
arable land remaining
in Malagasy hands
1.3 million hectares
may be leased by
South Korea’s
Daewoo Logistics
Figure 4
Percentage of Children Under-5 Underweight for Height
and GDP, per capita, Madagascar 1992–2004
Malnutritionprevalence,wasted
(%ofchildrenunder5)
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004GDPpercapitaPPP(constant2005int’l$)
Source: World Bank 2008, DHS 1992, DHS 2003/2004
950
900
850
800
750
14
12
10
8
6
4
2
GDP per capita, PPP (constant 2005 int’l 2005)
Malnutrition prevalence in children under-5, underweight for height: wasting
The rise in acute malnutrition
suggests that Madagascar is giving
less priority to the right to food of
its children than its neighbors
acute malnutrition, as measured by wasting, is
much more severe than chronic malnutrition as it
threatens not only the right to food and the right to
health, but even the right to life of the child. acute
malnutrition increases the likelihood of dying from
measles, malaria, pneumonia and diarrhea. The
near tripling of acute malnutrition in Madagas-
car is therefore of serious concern, and stands in
marked contrast to neighboring countries.
Half of Madagascar’s arable land may be
leased to grow crops for South Korea
In a context of high levels of chronic and acute
malnutrition among Madagascar’s children, it is of
serious concern that the government of Madagas-
car has reportedly agreed to lease 1.3 million hect-
ares of land to a south Korean corporation which
will grow crops (corn and palm oil) for seoul using
workers to be brought in from south africa. as
only five percent of Madagascar’s land is classified
as arable land, this means that 44 percent of Mad-
agascar’s arable land will now be used to promote
food security in south Korea, with very little ben-
efit for Madagascar (Financial Times 18/11/08).

4. C E S RMadagascar fact sheet no. 6
4
Source: WHO 2008
Madagascar
Zambia
Mozambique
Uganda
Kenya
Tanzania
Zimbabwe
50 75 100 125 150 175 200
49.4
92.4
108
108
91
93
57
141.8
191.7
196
172
149
137
72
Number of deaths per 1,000 live births, top (on left) and bottom (on right) quintiles
Figure 8
Mortality Gap for Children Under-5 between Rich and
Poor, Madagascar and its Neighbors
Source: DHS 1992, 2003/04
Toamasina Toliary Fianarantsoa Mahajanga Antsiranana Antananarivo
80%
70%
60%
50%
40%
30%
20%
10%
0%
1992 2003/2004
D�������
D�������
D�������
D�������
D�������
Figure 9
Percentage Births Attended by Skilled Health
Professionals by Province
Figure 7
Under-5 Mortality Rate (per 1,000 Children), by Malagasy
Province, 2003/2004
Source: DHS 2003/04
0
20
40
60
80
100
120
140
79.6
102.1
116.5
128.6
133.7
140.2
Antananarivo Fianarantsoa Antsiranana Toamasina Mahajanga Toliary
The right to health and to life is
not enjoyed equally by children
in all Madagascar’s provinces
children in Toliary province are almost twice as
likely to die before age five as children in the capi-
tal province of antananarivo. This may reflect a
lack of investment in rural areas in access to health
care and other resources necessary for enjoying
the rights to health and to life.
THE RIGHT TO HEalTH “The Committee is deeply concerned at the
high infant and under-5 mortality rates
and low life expectancy in the State party.”
(CRC Concluding Observations 2003)
Children from poor families are
more likely to die before age five
than children from rich families
This graph shows Madagascar has the largest gap
in mortality rates between children from rich and
poor families compared to other southern african
countries. The poorest 20 percent of Madagascar’s
children (with a mortality rate of 142 out of 1,000
live births) are almost three times as likely to die
as children from wealthy families (who have a
mortality rate of 49 out of 1,000).
The right to health of women has
less priority now than in 1992
There has been a significant fall in the coverage of
reproductive health services, with a fall in all but
one province of the proportion of births attended
by skilled health professionals between 1992 and
2003/4.

5. center for Economic and social rights
5
Figure 10
Percentage of Children Who Showed Vaccination Card,
by Region
Source: DHS 1992, 2003/04
Mahajanga Toamasina Toliary Fianarantsoa Antsiranana Antananarivo
70%
60%
50%
40%
30%
20%
10%
0%
1992 2003/2004
D������� D������� D������� D�������
D�������
Figure 11
Malaria Treatment and GDP per capita, Madagascar
2000–2004
GDPpercapitaPPP(constant2005int’l$)
Source: World Bank 2008
900
880
860
840
820
800
780
760
740
720
700
65
60
55
50
45
40
35
30
GDP per capita, PPP (constant 2005 int’l 2005)
Children with fever receiving antimalarial drugs (% of children under age 5 with fever)
Childrenwithfeverreceivingantimalarialdrugs
(%ofchildrenunderage5withfever)
2000 2001 2002 2003 2004
Source: World Bank 2008
Zimbabwe
South Africa
Tanzania
Zambia
Mozambique
Kenya
Uganda
Madagascar
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0
3.6
3.6
2.9
2.7
2.7
2.1
2.0
2.0
Figure 12
Public Health Expenditure as % of GDP
2005, Madagascar and its Neighbors
The right to health of children may also be
affected by falling vaccination coverage
The proportion of children with vaccination cards in
each province has also fallen, suggesting lower rates
of vaccination coverage. This may suggest a lower
priority and levels of resources for the realization of
the right to health of Madagascar’s children.
“The Committee also remains concerned
that health services in the local areas con-
tinue to lack adequate resources (both
financial and human) and that health
coverage is declining.” (CRC Concluding
Observations 2003)
Treatment for malaria has fallen, even
when more resources may be available
Malaria accounts for 20 percent of deaths for Mal-
agasy children under five years of age (UNIcEF
2008). Nevertheless, the rate of treatment more
than halved between 2000 and 2004, continuing
to fall in the years following the economic upturn.
This raises concerns about government efforts to
realize the right to health to the maximum of avail-
able resources.
Insufficient allocation of resources for
the realization of the right to health
compared with its neighbors in southern africa,
Madagascar spends the lowest amount on the
health sector as a percentage of its gdP. This
ratio is a reflection of government commitment to
providing healthcare, demonstrating the level of
resources the Malagasy government will invest in
the realization of this right. This low ratio suggests
a weak commitment to the realization of the right
to health.

6. C E S RMadagascar fact sheet no. 6
6
Figure 13
Percentage of Population with Access to Improved Water
and Sanitation by Malagasy Province, 2003/2004
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Improved Water Access Improved Sanitation Access
� Antananarivo� Mahajanga� Toliary� Antsiranana� Fianarantsoa� Toamasina
Source: DHS 2003/2004
Figure 14
Percentage of Rural Population with Access to Improved
Water Source, Sub-Saharan Africa, 2006
Source: World Bank 2008
Mauritius
Botswana
Namibia
Sao Tome & Principe
South Africa
Comoros
Gambia, The
Lesotho
Malawi
Zimbabwe
Ghana
Burundi
Burkina Faso
Côte d’Ivoire
Senegal
Sudan
Rwanda
Uganda
Guinea
Benin
Eritrea
Mauritania
Liberia
Central Afr. Rep.
Swaziland
Kenya
Mali
Cameroon
Gabon
Guinea-Bissau
Tanzania
Equatorial Guinea
Zambia
Chad
Togo
Angola
����������
Congo, Rep.
Niger
Sierra Leone
Ethiopia
Nigeria
Congo, Dem. Rep.
Mozambique
Somalia
0% 20% 40% 60% 80% 100%
36%
The right to water is not being enjoyed
equally by Malagasies across the provinces
Madagascar’s urban population living in the capi-
tal of antananarivo has much higher levels of
access to safe water and sanitation than the rest
of the country. antananarivo residents are nearly
three times as likely to have access to safe drink-
ing water as resident of Toamasina province and
more than seven times as likely to have access to
improved sanitation.
These wide disparities reflect the difference in
infrastructure and investment in the urban capital
area and the rest of the country. While urban-rural
disparities are common worldwide, these dispari-
ties raise concern about Madagascar’s efforts to
ensure equality in enjoying the basic human right
to water.
People living in rural areas of Madagascar
have access to safe water at rates well
below averages in Sub-Saharan Africa
More than 73 percent of Madagascar’s population
live in rural areas, but only 36 percent of them have
access to safe water (World Bank 2008). Mada-
gascar’s rural population has much lower access
to safe water than people living in rural areas in
other countries across sub-saharan africa. This
suggests that efforts to meet the needs of those
living in rural areas have been inadequate.
THE RIGHT TO WaTER “Concern is also expressed at …the poor
state of sanitation and the insufficient
access to safe drinking water, especially
in rural areas.” (CRC Concluding Obser-
vations 2003)

7. center for Economic and social rights
7
Figure 15
Population Living Below $1 per day (%), Sub-Saharan
Africa, Latest Available Data
Source: UNDP 2007/2008
Nigeria
Central Afr. Rep.
Zambia
����������
Niger
Rwanda
Gambia
Tanzania
Sierra Leone
Zimbabwe
Burundi
Swaziland
Ghana
Lesotho
Mozambique
Mali
Namibia
Benin
Botswana
Burkina Faso
Mauritania
Ethiopia
Kenya
Malawi
Cameroon
Senegal
Côte d’Ivoire
South Africa
0% 20% 40% 60% 80%
61%
Figure 16 Gini Index and GDP per capita, Madagascar 1993–2001
GDPpercapitaPPP(constant2005intl$)
Source: World Bank 2008
890
880
870
860
850
840
830
820
810
49
47
45
43
41
39
37
GDP per capita, PPP (constant 2005 int’l 2005) Gini Index
GiniIndex
1993 1994 1995 1996 1997 1998 1999 2000 2001
Figure 17
Taxes on Income, Profits and Capital Gains (% of
Revenue), Madagascar and Its Neighbors, 2006*
Source: World Bank 2008
South Africa
Zambia
Kenya
Uganda
MADAGASCAR
* Kenya 2005
Income, profits and capital gains taxes Other taxes (including sales tax)
18.6
27.1
37.6
42.4
55.8
81.4
72.9
62.4
57.6
44.2
The majority of Malagasies
live on less than $1 a day
almost two-thirds of Malagasies live on less than
$1 a day, making it difficult for them to meet the
minimum calorie requirements and basic non-food
needs. This is one of the highest rates of poverty in
sub-saharan africa.
Increased national wealth has not
trickled down to all Malagasies
This graph shows that although national income
(in terms of gdP per capita) has risen, this has
been accompanied by rising inequality. (This is
measured in Fig. 16 by the gini Index, a measure
of inequality of wealth or income where a higher
percentage indicates greater inequality.) This sug-
gests that the benefits of growth and development
have been unevenly spread. It also and raises con-
cerns about Madagascar’s commitment to use
the maximum of available resources to ensure
progressive realization and equal enjoyment of
economic and social rights.
Tax policies reflect a weak
commitment to fulfilling the right
to an adequate standard of living
Tax policies are an essential means of generating
the resources needed to realize the equal right
of all members of the population to an adequate
standard of living. Madagascar, however, in com-
parison with its neighbors (for which data was
available) has the lowest rates of income taxes as
a percentage of its revenue and as a percentage of
its total taxes. In addition, industries in the export-
processing zones (EPZ), have been excused from
most taxation (EIU 2008). This suggests a regres-
sive system of taxation with indirect, consumption
taxes as the main income source for the govern-
ment’s budget, placing a disproportionate burden
on the poor.
POvERTy and InEqualITy

8. C E S RMadagascar fact sheet no. 6
8
References
Committee on the Rights of the Child (CRC). concluding Observations: Madagascar
27/10/2003.
dHS 1992. Madagascar: standard demographic and Health survey. central Bureau of
statistics.
dHS 2003/2004. Madagascar: standard demographic and Health survey. central Bureau of
statistics.
dHS 2008. demographic and Health survey sTaTcompiler. www.statcompiler.com
Economist Intelligence unit. country Profile 2007 and Main report and country report
september 2008. www.eiu.com
FaO Country Profile. agriculture and consumer Protection department. republic of
Madagascar country Profile 2008. www.fao.org/ag/agn/nutrition/mdg_en.stm
Financial Times, november 18, 2008. “Land Leased to secure crops for south Korea”
www.ft.com/cms/s/0/98a81b9c-b59f-11dd-ab71-0000779fd18c.html
undP 2007/2008. United Nations development Programme. statistics of the Human
development report 2007/2008. www.hdr.undp.org/en/statistics
unICEF 2008. “countdown to 2015: Maternal, Newborn and child survival.” 2008 report.
www.countdown2015mnch.org/documents/2008report/2008countdown2015
fullreport.pdf
World Health Organization (WHO). WHO statistical Informational system (WHOsIs)
2008. www.who.int/whosis
World Bank 2008. World development Indicators. www.worldbank.org
about This Fact Sheet Series
This series is intended to contribute to the ongoing monitoring work of UN and other inter-
governmental human rights mechanisms to monitor governments’ compliance with their eco-
nomic, social and cultural rights obligations. It is also intended to contribute to strengthening
the monitoring and advocacy capabilities of national and international NgOs. drawing on the
latest available socioeconomic data, the country fact sheets display, analyze and interpret
selected human development indicators in the light of three key dimensions of governments’
economic and social rights obligations.
Firstly, indicators such as maternal mortality or primary completion rates are used to
assess the extent to which the population is deprived of minimum essential levels of the
right to health, education, food and other economic and social rights. secondly, data tracking
progress over time can help to assess whether a state is complying with its obligation to real-
ize rights progressively according to maximum available resources. comparisons within the
same region provide a useful benchmark of what has been achieved in countries with similar
resources. Finally, data disaggregated by gender, ethnicity, geographical location and socio-
economic status is used to identify disparities and assess progress in eliminating discrimina-
tion and unequal enjoyment of these rights.
The fact sheets are not meant to give a comprehensive picture, nor provide conclusive
evidence, of a country’s compliance with these obligations. rather, they flag some possible
concerns which arise when development statistics are analyzed and visualized graphically in
light of international human rights standards.
Board Members
Victor Abramovich, Inter-American
Commission on Human Rights
Philip Alston (Chairperson),
New York University School of Law
Linda Cassano (Treasurer),
Commonwealth Bank of Australia
Sakiko Fukuda-Parr,
The New School, New York
Richard Goldstone,
Harvard Law School
Chris Jochnick, Oxfam America
Jose Maria Maravall,
Juan March Institute, Madrid
Alicia Ely Yamin, Harvard Law School
Acting Executive Director: Ignacio Saiz
About CESR
The Center for Economic and Social
Rights (CESR) was established in 1993
with the mission to work for the recog-
nition and enforcement of economic,
social and cultural rights as a power-
ful tool for promoting social justice and
human dignity. CESR exposes violations
of economic, social and cultural rights
through an interdisciplinary combination
of legal and socio-economic analysis.
CESR advocates for changes to economic
and social policy at the international,
national and local levels so as to ensure
these comply with international human
rights standards.
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