The first 28 days of life – the neonatal period – are the most vulnerable time for a child’s survival. Children face the highest risk of dying in their first month of life, at a global rate of 19 deaths per 1,000 live births. By way of comparison, the probability of dying after the first month but before reaching age 1 is 12, and after age 1 but before turning age 5 is 11. Globally, 2.6 million children died in the first month of life in 2016 – approximately 7,000 newborn deaths every day – most of which occurred in the first week, with about 1 million dying on the first day and close to 1 million dying within the next six days.
Neonatal mortality declined globally and in all regions but more slowly than mortality among children aged 1–59 months. The global neonatal mortality rate fell from 37 deaths per 1,000 live births in 1990 to 19 per 1,000 in 2016. However, the decline in the neonatal mortality rate from 1990 to 2016 was slower than the decline in mortality among children aged 1–59 months: 49 per cent, compared with 62 per cent, a pattern consistent across all regions.
Lower under-five mortality is associated with a higher concentration of under-five deaths occurring during the neonatal period. The share of neonatal deaths among under-five deaths is still relatively low in sub-Saharan Africa (36 per cent), which remains the region with the highest under-five mortality rates. In regions where under-five mortality rates are low, more than half of all under-five deaths occur during the neonatal period. The only exception is South Asia, where the proportion of neonatal deaths is among the highest (59 per cent) despite a relatively high under-five mortality rate.
Marked disparities in neonatal mortality exist across regions and countries. Among the regions, neonatal mortality was highest in sub-Saharan Africa and South Asia, which each reported 28 deaths per 1,000 live births. A child in sub-Saharan Africa or in South Asia is nine times more likely to die in the first month than a child in a high-income country. Across countries, neonatal mortality rates ranged from 46 deaths per 1,000 live births in Pakistan to 1 each in Iceland and Japan. The risk of dying for a newborn in the first month of life is about 50 times higher in Pakistan than in Japan.
Globally, the main causes of neonatal deaths were preterm birth complications (35 per cent), intrapartum related events (24 per cent), and sepsis (15 per cent). Most deaths of children under age 5 are caused by diseases that are readily preventable or treatable with proven, cost-effective interventions.
This report presents the group’s latest estimates of under-five, infant and neonatal mortality up to the year 2016, and assesses progress at the country, regional and global levels. Critically, it shows that although the number of children dying before the age of five has reached a new low – 5.6 million in 2016, compared with nearly 9.9 million in 2000 – the proportion of under-five deaths in the newborn period has increased from 41 per cent to 46 per cent during the same period. For the first time, the report also provides mortality estimates for children aged 5 to 14.
Since its initiation, A Promise Renewed has focused on promoting two goals: first, keeping the promise of Millennium Development Goal (MDG) 4 – to reduce the under-five mortality rate by two thirds, between 1990 and 2015; and second, continuing the fight beyond 2015, until no child or mother dies from preventable causes. By focusing on priority actions and core principles, countries are already achieving progress, bending the curve on child mortality and moving towards a world where no mother or child dies from a preventable cause. As we begin the work of the Sustainable Development Goals, maintaining this momentum must be our top priority.
This report presents the group’s latest estimates of under-five, infant and neonatal mortality up to the year 2015, and assesses progress at the country, regional and global levels. The report also provides an overview on the estimation methods used for child mortality indicators.
This commentary summarizes the levels and trends in child mortality as well as the coverage and quality of key maternal and newborn care from pregnancy through childbirth and the postnatal period as discussed in the UNICEF report Committing to Child Survival: A Promise Renewed Progress Report 2014.
This report looks at causes of death and coverage of key interventions for mother and newborn and highlights initiatives by governments, civil society and the private sector to accelerate progress on child survival.
Recent estimates show that the number of under-five deaths worldwide has declined by half since 1990, from 12.7 million to 6.3 million today. Yet, 17,000 children under age five still die every day in 2013.
National, regional, and global sex ratios of infant, child, and under-5 mortality and identifi cation of countries with outlying ratios: a systematic assessment
The Lancet, vol. 2, no.9, 2014, pp. e521-e530.
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 28 days of life, expressed per 1,000 live births.
Probability of dying among children aged 5–14: Probability of dying at age 5–14 years expressed per 1,000 children aged 5.
DATA SOURCES AND METHODOLOGY
If each country had a single source of high-quality data covering the last few decades, reporting on child mortality levels and trends would be straightforward. But few countries do, and the limited availability of high-quality data over time for many countries makes generating accurate estimates of child mortality a considerable challenge.
Nationally representative estimates of child mortality can be derived from several sources, including civil registration, censuses and sample surveys. Demographic surveillance sites and hospital data are excluded because they are rarely nationally representative. The preferred source of data is a civil registration system that records births and deaths on a continuous basis, collects information as events occur and covers 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 remain without viable or fully functioning vital registration systems that accurately record all births and deaths—only around 60 countries have such systems. Therefore, household surveys, such as the UNICEF-supported Multiple Indicator Cluster Surveys and the US Agency for International Development–supported Demographic and Health Surveys, which ask women about the survival of their children, are the basis of child mortality estimates for most developing countries.
The United Nations Inter-agency Group for Child Mortality Estimation (UN 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 2016 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 national available data and estimated under-five mortality rates as input. Mortality rates among children aged 5–14 were produced by using a similar model as for under-five mortality. These methods provide a transparent and objective way of fitting a smoothed trend to a set of observations and of extrapolating the trend from the earliest available data point to the present. A more detailed explanation is available in the explanatory notes.
An overview on the methodology is available in this year’s UN IGME report.
To increase transparency of UN IGME’s methodology for child mortality estimation a peer-reviewed collection of articles is available through PLoS Medicine. Topics include: an overview of the child mortality estimation methodology developed by UN 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.
More details on the data used in deriving estimates are available in CME Info http://www.childmortality.org.
- For a detailed description of the B3 methodology, see Alkema, L. and New, J.R. (2014). ‘Global estimation of child mortality using a Bayesian B-spline bias-reduction method’, Annals of Applied Statistics, Vol. 8, No. 4, 2122-2149. Available at http://arxiv.org/abs/1309.1602 [PDF].
- Full details of the methodology used in the estimation of child mortality for 2015 are available in the PLOS Medicine Collection on Child Mortality Estimation methods (ploscollections.org/childmortalityestimation).
- For changes to methods used for the 2016 estimates, refer to this years report.
Alkema, L. et al., ‘National, regional, and global sex ratios of infant, child, and under-5 mortality and identification of countries with outlying ratios: a systematic assessment’, The Lancet Global Health, vol. 2, 9, 1 September 2014, pp. e521-e530, DOI: 10.1016/S2214-109X(14)70280-3 Available at http://arxiv.org/abs/1309.1602 [PDF].
Alexander, M., and L. Alkema, ‘Global Estimation of Neonatal Mortality Using a Bayesian Hierarchical Splines Regression Model’, 2016, available at <https://arxiv.org/abs/1612.03561>.
You, D. et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. The Lancet. 2015; 386: 2275–2286.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2017.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2015.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2014.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2013.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2012.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2010.
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]