A Promise Renewed reiterates the significant progress made in improving child survival. The global under-five mortality rate has declined by almost half, dropping from 90 deaths per 1,000 live births in 1990 to 46 per 1,000 in 2013. The estimated annual number of under-five deaths was cut in half during the same period, from 12.7 million to 6.3 million. This means that in 2013, every single day, 17,000 less children died than in 1990 — thanks to more effective and affordable treatments, innovative ways of delivering critical interventions to the poor and excluded, and sustained political commitment. These and other vital child survival interventions have helped to save almost 100 million lives over the past 2 decades. The pace of decline has accelerated, with the global annual rate of reduction more than tripling since the early 1990s.
But challenges remain. The world is off track to achieve MDG 4. If current trends continue, the world will not fulfil its promise to reduce the global under-five mortality rate by two-thirds until 2026 – 11 years behind schedule. Globally, about 44 per cent of deaths in children under age five occurred during the first 28 days of life – the neonatal period – with the day of birth sadly representing the day of death for 1 million babies.