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Current Status + Progress
Since 1990, the number of deaths in children under 5 has declined by nearly half

From 1990 to 2012, the number of deaths in children under 5 fell from 12.6 million to 6.6 million. Despite this admirable accomplishment, progress must be accelerated to meet Millennium Development Goal 4: Reduce child mortality. Going beyond the MDG deadline, the momentum to improve child survival must be sustained in all regions.

Since 1990, the lives of an estimated 90 million children under age 5 have been saved, but much work remains. If current trends continue, the world will not meet the MDG target until 2028, and another 35 million children will die unnecessarily. 

UNDER-FIVE MORTALITY

Worldwide, the under-five mortality rate has dropped 47 per cent – well short of the two-thirds reduction required by the MDG target. The number of deaths per 1,000 live births dropped from 90 deaths in 1990 to 48 in 2012. However, stepped-up progress is needed to reach the target of 30 deaths per 1,000 live births by 2015.

Despite impressive gains, the pace of progress must quicken to meet the MDG target by 2015
Neonatal, infant and under-five mortality rate (number of deaths per 1,000 live births) worldwide, 1990─2012

Source: UNICEF analysis based on estimates developed by IGME, as published in:  UNICEF, Committing to Child Survival: A promise renewed – Progress report 2013, UNICEF, New York, 2013.

Every region has at least halved its under-five mortality rate, with the exception of West and Central Africa and sub-Saharan Africa as a whole. East Asia and the Pacific and Latin America and the Caribbean are both on track to achieve the MDG target.

Substantial progress has been made in every region, but sub-Saharan Africa lags behind

* Central and Eastern Europe and the Commonwealth of Independent States.

Source: UNICEF analysis based on estimates developed by IGME, as published in: UNICEF, Committing to Child Survival: A promise renewed – Progress report 2013, UNICEF, New York, 2013.

Although the global number of under-five deaths has dropped since 1990, nearly 18,000 children still died each day in 2012. Infectious diseases (such as pneumonia, diarrhoea and malaria), malnutrition and neonatal complications are responsible for the vast majority of these deaths — nearly all of which are preventable.

Most deaths in children under 5 are preventable

Source: UNICEF analysis based on IGME 2013, drawing on provisional analyses by the World Health Organization (WHO) and the Child Health Epidemiology Reference Group (CHERG) 2013. References: Liu, L., et al., ‘Global, Regional, and National Causes of Child Mortality: An updated systematic analysis for 2010 with time trends since 2000’, Lancet, vol. 379, no. 9832, 9 June 2012, pp. 2151─2161; WHO, ‘WHO-CHERG Methods and Data Sources for Child Causes of Death 2000─2011’, Global Health Estimates Technical Paper WHO/HIS/HSI/GHE/2013.2, WHO, Geneva. 

Accelerating progress in child survival requires urgent attention to ending preventable deaths in sub-Saharan Africa and South Asia, which together account for more than 80 per cent of deaths in children under 5 globally. South Asia has made strong progress in reducing preventable deaths, more than halving the number of deaths in under-fives since 1990. Sub-Saharan Africa, however, continues to lag behind, with a decrease in under-five mortality of 45 per cent over the same time period. However, along with the Middle East and North Africa, it is one of only two regions that have experienced a consistent acceleration in the pace of progress since 1990.

Reductions in child mortality continue to accelerate in sub-Saharan Africa

Source: UNICEF analysis based on estimates developed by IGME, as published in:  UNICEF, Committing to Child Survival: A promise renewed – Progress report 2013, UNICEF, New York, 2013.

Although accelerated progress is being made in sub-Saharan Africa, the severity of the problem in that region cannot be ignored. Its under-five mortality rate of 98 deaths per 1,000 live births is higher than any other region. And by mid-century, it will have largest population of children under 5, accounting for 37 per cent of the global total and close to 40 per cent of all live births.

Countries with high rates of under-five mortality are concentrated in sub-Saharan Africa and South Asia

Source: UNICEF analysis based on estimates developed by IGME, as published in: UNICEF, 2013 Statistical Snapshot: Child mortality, UNICEF, New York, 2013.

Of the 61 high-mortality countries (at least 40 under-five deaths per 1,000 live births in 2012), 25 countries reduced their under-five mortality rate by at least 50 per cent between 1990 and 2012. Seven countries have reduced their rate by two thirds or more: Bangladesh, Ethiopia, Liberia, Malawi, Nepal, Timor-Leste and the United Republic of Tanzania.

The data show that progress in child survival is not necessarily dependent on a country’s wealth. The annual rate of reduction in under-five mortality has accelerated since 1995 at all national income levels (with the exception of high-income countries). Gains in low- and middle-income countries in particular have been substantial. And strong reductions in under-five mortality in some of the world’s poorest countries since 1990 – and particularly since 2000 – show that low income need not be an impediment to saving children’s lives.

Many low-income countries have made significant progress in reducing child deaths

Note: The size of each bubble represents the number of under-five deaths in a country in 2012.

Source: UNICEF analysis based on estimates developed by the IGME, as published in: UNICEF, Committing to Child Survival: A promise renewed – Progress report 2013, UNICEF, New York, 2013.

Great strides have been made since 1990. However, if current trends continue, the world will not meet the MDG target until 2028, and another 35 million young children will die unnecessarily between 2015 and 2028. 

Progress in child survival has saved 90 million lives worldwide, but much more can and must be done

Source: UNICEF analysis based on estimates developed by IGME, as published in: UNICEF, Committing to Child Survival: A promise renewed – Progress report 2013, UNICEF, New York, 2013.

REFERENCES

  1. The UN Inter-agency Group for Child Mortality Estimation (IGME), Levels and Trends in Child Mortality: Report 2013, UNICEF, New York, 2013.
  2. UNICEF, Committing to Child Survival: A promise renewed – Progress report 2013, UNICEF, New York, 2013.
  3. Liu, L., et al., ‘Global, Regional, and National Causes of Child Mortality: An updated systematic analysis for 2010 with time trends since 2000’,  Lancet, vol. 379, no. 9832, 9 June 2012, pp. 2151─2161; WHO, ‘WHO-CHERG Methods and Data Sources for Child Causes of Death 2000─2011’, Global Health Estimates Technical Paper WHO/HIS/HSI/GHE/2013.2, WHO, Geneva.
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Publication

Committing to Child Survival: A Promise Renewed Progress Report 2013

Produced by UNICEF on behalf of the A Promise Renewed Initiative

Committing to Child Survival: A Promise Renewed is a global movement to end preventable child deaths. Under the leadership of participating governments and in support of the United Nations Secretary-General’s Every Woman Every Child strategy, A Promise Renewed brings together public, private and civil society actors committed to advocacy and action for maternal, newborn and child survival.

 

Notes on the Data

DEFINITION OF INDICATORS

  • Under-five mortality rate: Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.
  • Infant mortality rate: Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.
  • Neonatal mortality rate: Probability of dying during the first month of life, expressed per 1,000 live births.

DATA SOURCES AND METHODOLOGY

Generating accurate estimates of child mortality is a considerable challenge because of the limited availability of high-quality data for many countries. Vital registration systems are the preferred source of data on child mortality because they collect information as events occur and they cover the entire population. If registration coverage is complete and the systems function efficiently, the resulting child mortality estimates will be accurate and timely. However, many countries lack fully functioning vital registration systems that accurately record all births and deaths. Therefore, household surveys, such as the UNICEF-supported Multiple Indicator Cluster Surveys (MICS) and the US Agency for International Development–supported Demographic and Health Surveys (DHS) have become the primary sources of data on child mortality in countries without functioning vital registration systems. These surveys ask women about the survival of their children, and they provide the basis for child mortality estimates for most of these countries.

The United Nations Inter-agency Group for Child Mortality Estimation (IGME) seeks to compile all available national-level data on child mortality, including data from vital registration systems, population censuses, household surveys and sample registration systems. To estimate the under-five mortality trend series for each country, a statistical model is fitted to data points that meet quality standards established by IGME and then used to predict a trend line that is extrapolated to a common reference year, set at 2012 for the estimates presented here. Infant mortality rates are generated by either applying a statistical model or transforming under-five mortality rates based on model life tables. Neonatal mortality rates are produced using a statistical model that uses under-five mortality rates as input. These methods provide a transparent and objective way of fitting a smoothed trend to a set of observations and of extrapolating the trend from 1960 to the present.

A peer-reviewed collection of articles that makes a vital contribution to transparency on IGME's methodology for child mortality estimation.

Topics include: an overview of the child mortality estimation methodology developed by IGME, methods used to adjust for bias due to AIDS, estimation of sex differences in child mortality, and more. The collection was produced with support from UNICEF and the independent technical advisory group of IGME. Read more.

CHANGE IN ESTIMATION PROCESS

IGME continually seeks to improve its methods and may introduce changes from one year to the next. In 2013, a new estimation method was used for estimating and extrapolating the under-five mortality rate, referred to as the Bayesian B-splines bias-adjusted model, or the B3 model. Compared with the Loess estimation approach that IGME used in previous years, the B3 model better accounts for data errors, including biases and sampling and non-sampling errors in the data; it can better capture short-term fluctuations in the under-five mortality rate and its annual rate of reduction. Thus, it is better able to account for evidence of acceleration in the decline of under-five mortality from new surveys. Validation exercises show that the B3 model also performs better in projections. In 2012 IGME produced estimates of the under-five mortality rate for males and females separately for the first time. In many countries, fewer sources have provided data by sex than have provided data for both sexes combined. For this reason, IGME uses the available data by sex to estimate a time trend in the sex ratio (male : female) of child mortality, rather than estimate child mortality trends by sex directly from reported sex-specific mortality rates. This year, new Bayesian methods have been developed by IGME for estimating sex ratios of child mortality, with a focus on identifying countries with outlying levels or trends.
More details on the data used in deriving estimates are available in CME Info (www.childmortality.org).

KEY REFERENCES

  • A detailed description of the B3 methodology is available at: http://arxiv.org/abs/1309.1602 [PDF].
  • Full details of the methodology used in the estimation of child mortality for 2012 are available in the PLOS Medicine Collection on Child Mortality Estimation methods (www.ploscollections.org/childmortalityestimation).
  • For changes to methods used for the 2012 estimates, refer to Annex – Technical Notes
  • For changes to data and methods used for the 2010 estimates click here.
  • For detailed information on the methodology used for the 2009 estimates, see Estimation Methods used by the UN Inter-agency Group for Child Mortality Estimation.
  • The full details of the methodology used in the estimation of infant and under-five mortality rates for 2006 are available in the following working paper: UNICEF, WHO, The World Bank and UN Population Division, Levels and Trends of Child Mortality in 2006: Estimates developed by the Inter-agency Group for Child Mortality Estimation’, New York, 2007. Working Paper [PDF]

Other references include:

  • Hill, K., et al., Trends in Child Mortality in the Developing World: 1960-1996 Download (ZIP)
  • UNICEF, WHO, The World Bank, United Nations Population Division, Levels and Trends in Child Mortality: Report 2012. Download (PDF)
  • UNICEF, WHO, The World Bank, United Nations Population Division, Levels and Trends in Child Mortality: Report 2011Download (PDF)
  • UNICEF, WHO, The World Bank, the United Nations Population Division, Levels and Trends in Child Mortality: Report 2010. Download (PDF)