Since 1990, the world has cut both the rate and number of child deaths by more than one half. This progress, while remarkable, falls short of the Millennium Development Goal 4 (MDG 4) target of a two-thirds reduction in the under-five mortality rate. In 2015, an estimated 5.9 million children under the age of five will still die, equivalent to 11 every minute. This underscores that child survival needs to be a continued priority when we look beyond the MDGs.

UNDER-FIVE MORTALITY

The global under-five mortality rate has fallen by 53 per cent, from 91 deaths per 1,000 live births in 1990 to an estimated 43 in 2015. The infant mortality rate has fallen by nearly half. Neonatal mortality has declined less steeply than the other rates, dropping 47 per cent. Over the same period, the absolute number of child deaths per year has also fallen substantially. In 1990, 12.7 million children around the world died before reaching their fifth birthday; in 2015, that number has fallen to 5.9 million children. Over the same period, the number of newborn babies who died within the first 28 days of life declined from 5.1 million to 2.7 million.

Both the under-five mortality rate and the number of under-five deaths have fallen by more than half since 1990

Global under-five, infant and neonatal mortality rates and number of deaths, 1990-2015

Note: The shaded bands in Figure 1A are the 90 per cent uncertainty intervals around the estimates of under-five mortality rates.

Source: United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2015, UNICEF, New York 2015.

This progress, while remarkable, falls short of the MDG 4 target of a two-thirds reduction in the under-five mortality rate. If every country had further accelerated progress in improving child survival since 2000 and achieved the MDG 4 target by 2015, an additional 14 million under-five deaths would have been averted between 2000 and 2015.

At a regional level, the overall trends are positive but vary. Since 1990, every region of the world has reduced its under-five mortality rate by at least half. East Asia and the Pacific and Latin America and the Caribbean each met the MDG 4 target of a two-thirds reduction in the under-five mortality rate.

Every region has reduced under-five mortality by at least half since 1990

Percentage decline in under-five mortality rate by region, 1990-2015

* Central and Eastern Europe and the Commonwealth of Independent States

Note: The blue bar shows the median estimate, and the yellow vertical lines represent the 90 per cent uncertainty intervals around the value.

Source: United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2015, UNICEF, New York 2015.

Promisingly, progress in reducing under-five mortality in sub-Saharan Africa – the region with the highest under-five mortality rate in the world – has been accelerating even faster than the global average. Its annual rate of reduction increased from just 1.6 per cent in the 1990s to 4.1 per cent over the 2000-2015 period, and all but five of the 49 sub-Saharan African countries had higher annual rates of reduction in 2000-2015 than in the 1990s.

Progress on reducing under-five mortality is accelerating

Annual rate of reduction in the under-five mortality rate, per cent, by region, 1990–2000 and 2000–2015

Source: United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2015, UNICEF, New York 2015.

At a national level, sixty-two countries have met the MDG 4 target for reducing under-five mortality by two-thirds between 1990 and 2015. Among them are 12 low-income countries and another dozen lower-middle income countries. These successes demonstrate that dramatic reductions are possible even in resource-constrained settings.

While falling short of the MDG 4 target, another 74 countries cut their under-five mortality rates by at least half. Combined, 70 per cent of the 195 countries with available data reduced under-five mortality by 50 per cent or more.

Sixty-two countries met the MDG 4 target of reducing under-five mortality rates by two thirds from 1990 levels

Percentage decline in under-five mortality rate, 1990–2015 and gross domestic product (GDP) per capita, by country, 2014

How to read the graph: Each bubble represents a country. The size of each bubble represents the number of estimated under-five deaths in the country in 2015. Countries above the blue horizontal line achieved a two-thirds reduction.

Source: United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2015, UNICEF, New York 2015.

Even with the progress made in reducing under-five deaths during the MDG period, over the past 25 years, a total of 236 million children died before reaching their fifth birthday. This number is staggering – more than the current population of Brazil, the world’s fifth most populous country. About 16,000 children under the age of five still die every day.

The remaining burden of child mortality is not evenly shared across regions and countries. The 5.9 million under-five deaths that are estimated to occur in 2015 are heavily concentrated in sub-Saharan Africa and South Asia, and in lower income countries.

The highest national under-five mortality rates are found in sub-Saharan Africa

Under-five mortality rate and under-five deaths by country, 2015

Note: The number of under-five deaths is affected by not only the under-five mortality rates but also the under-five population in a country

Source: United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2015, UNICEF, New York 2015.

This map does not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. The final boundary between the Sudan and South Sudan has not yet been determined. The final status of the Abyei area has not yet been determined.

Globally, the main killers of children under age five in 2015 were pneumonia (16 per cent), preterm birth complications (16 per cent), intrapartum-related complications (11 per cent), diarrhoea (9 per cent), neonatal sepsis (7 per cent) and malaria (5 per cent). Infectious diseases and neonatal complications are responsible for the vast majority of under-five deaths around the world. Of the 5.9 million under-five deaths in 2015, almost half were caused by leading infectious diseases and conditions such as pneumonia, diarrhoea, malaria, meningitis, tetanus, measles, sepsis and AIDS.

Despite progress, key infectious diseases remain the main killers of children under age 5; preterm birth and intrapartum-related complications are responsible for the majority of neonatal deaths

Global distribution of deaths among children under age five by cause, 2015

Source: WHO and Maternal and Child Epidemiology Estimation Group (MCEE) provisional estimates 2015

 

The leading causes of under-five deaths vary between high and low mortality groupings and among high mortality regions. In very-low-mortality countries (with an under-five mortality less than 10 deaths per 1,000 live births in 2015), infectious diseases are not the main causes of death for children under five. In those countries, pneumonia, diarrhoea, malaria, sepsis, pertussis, tetanus and meningitis, measles and AIDS together only account for 10 per cent of all under-five deaths. In higher-mortality regions, however, these key infectious diseases still kill many children under age 5, accounting for 39 per cent, 54 per cent and 47 per cent of all under-five deaths in South Asia, West and Central Africa, and Eastern and Southern Africa, respectively.

Infectious diseases remain the main killers of children under age five in Sub-Saharan Africa

Distribution of deaths among children under age 5 by cause, by region, 2015

Very-low-mortality countries are those with an under-five mortality rate of less than 10 deaths per 1,000 live births in 2015.

Note: Estimates are rounded and therefore may not sum up to 100%.

Source: WHO and Maternal and Child Epidemiology Estimation Group (MCEE) provisional estimates 2015

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