The world made substantial progress in reducing child mortality in the past few decades. Globally, the under-five mortality rate dropped from 93 deaths per 1,000 live births in 1990 to 41 in 2016. Progress in reducing child mortality has been accelerated in the 2000–2016 period compared with the 1990s – globally, the annual rate of reduction in the under-five mortality rate has increased from 1.9 per cent in 1990–2000 to 4.0 per cent in 2000–2016. The remarkable progress in improving child survival since 2000 has saved the lives of 50 million children under age 5 – children who would have died had under-five mortality remained at the same level as in 2000 in each country.
The global under-five mortality rate declined by 56 per cent, from 93 deaths per 1,000 live births in 1990 to 41 per 1,000 in 2016. Despite substantial progress, improving child survival remains a matter of urgent concern. In 2016, an estimated 5.6 million children died before reaching their fifth birthday, mostly from preventable diseases. This translates to 15,000 under-five deaths per day, an intolerably high number of largely preventable child deaths.
The majority of the regions in the world and 142 out of 195 countries at least halved their under-five mortality rate. Among all countries, more than a third (67) cut their under-five mortality by two-thirds – 28 of them are low- or lower-middle-income countries, indicating that improving child survival is possible even in resource-constrained settings.
Huge disparities in under-five mortality exist across regions and countries. Sub-Saharan Africa remains the region with the highest under-five mortality rate in the world. The risk of dying for a child born in the highest mortality country is about 60 times higher than in the lowest mortality country. All six countries with mortality rates above 100 deaths per 1,000 live births are in sub-Saharan Africa.
The burden of under-five deaths remains unevenly distributed. About 80 per cent of under-five deaths occur in two regions, sub-Saharan Africa and South Asia. Six countries account for half of the global under-five deaths, namely, India, Nigeria, Pakistan, the Democratic Republic of the Congo, Ethiopia and China. India and Nigeria alone account for almost a third (32 per cent) of the global under-five deaths.
Ending newborn and child deaths from preventable infectious diseases is critical. Despite strong advances in fighting childhood illnesses, infectious diseases – which are most often diseases of the poor and thus are a marker of equity – remain highly prevalent, particularly in sub-Saharan Africa and South Asia. Pneumonia, diarrhoea and malaria remain among the leading causes of death among children under age 5 – accounting for almost a third of global under-five deaths and about 40 per cent of under-five deaths in sub-Saharan Africa. The main killers of children under age 5 in 2016 included preterm birth complications (18 per cent), pneumonia (16 per cent), intrapartum-related events (12 per cent), diarrhoea (8 per cent), neonatal sepsis (7 per cent) and malaria (5 per cent).
Every year, 2.6 million babies die before turning one month old.1 One million of them take their first and last breaths on the day they are born. Another 2.6 million are stillborn. Each of these deaths is a tragedy, especially because the vast majority are preventable. More than 80 per cent of newborn deaths are the result of premature birth, complications during labour and delivery and infections such as sepsis, meningitis and pneumonia. Similar causes, particularly complications during labour, account for a large share of stillbirths.
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.
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
Despite substantial progress in reducing child mortality, concerted efforts remain necessary to avoid preventable under-5 deaths in the coming years and to accelerate progress in improving child survival further. Urgent actions are needed most in the regions and countries with high under-5 mortality rates, particularly those in sub-Saharan Africa and south Asia.
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]