A child in Angola is 20 times more likely to die before the age of 5 than one in the United States. Children in parts of sub-Saharan Africa are among the worst off in the world, according to a report from the international NGO, Save the Children, which ranks 172 countries based on where childhood is the most protected and where it’s been eroded the most.

European countries like Norway, Slovenia, and Finland rank first while Niger, Angola, and Mali came in last. The US ranked 36th. Out of the 10 countries at the bottom of the list, seven were in West or Central Africa. “Children in these countries are the least likely to fully experience childhood, a time that should be dedicated to emotional, social and physical development, as well as play,” the report (pdf) said.

Country Rank Guinea 163 Sierra Leone 163 Burkina Faso 165 South Sudan 166 Chad 167 Somalia 168 Central African Republic 169 Mali 170 Angola 171 Niger 172

Country Rank Norway 1 Slovenia 2 Finland 3 Netherlands 4 Sweden 5 Portugal 6 Ireland 7 Iceland 8 Italy 9 Belgium 10

Using government and United Nations data, researchers looked at indicators like mortality for children under the age of 5, malnutrition, access to schooling, child labor, early marriage, displacement from conflict, and child homicide. African countries ranked the lowest on several of these.

The highest rates of child mortality are in African countries like Angola, Chad, Mali, Nigeria, Sierra Leone, Somalia, and the Central African Republic, where more than 10% of children die before their fifth birthday. That rate is at least 40 times that of Finland or Japan. African countries also have the highest rates of child labor and child marriage.

Still, there have been some signs of progress in the worst ranked countries. Mortality rates for children in West and Central Africa under the age of 5 have fallen by half since 1990. Niger, the last ranked country, has seen child mortality fall by more than two thirds. Nine other countries in the region—Burkina Faso, Cameroon, Côte d’Ivoire, Mauritania, Congo, Central African Republic, Senegal, Sierra Leone, and Gabon—have improved, or at least halted, increasing rates of child deaths.