In 2015, the world began working toward a new global development agenda, seeking to achieve, by 2030, new targets set out in the Sustainable Development Goals (SDGs). The proposed SDG target for child mortality aims to end, by 2030, preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births and under-5 mortality to at least as low as 25 deaths per 1,000 live births.
Accelerated progress will be needed in more than a quarter of all countries to achieve SDG targets in child survival. Among all 195 countries analysed, 116 already met the SDG target on under-five mortality and 27 countries are expected to meet the target by 2030 if current trends continue, while 52 countries need to accelerate progress. These countries can be found in most regions of the world, but the majority are in sub-Saharan Africa. If current trends continue, more than three quarters of all countries in sub-Saharan Africa will miss the under-five mortality target, and 13 countries in the region will not reach the target until after 2050.
Many countries will lag even further behind in achieving the SDG target on neonatal mortality than on under-five mortality if current trends continue. On current trends, more than 60 countries will miss the target for neonatal mortality by 2030. About half of these countries would not even reach the neonatal mortality target by 2050. These 60+ countries carried about 80 per cent of the burden of neonatal deaths in 2016.
Achieving the SDG target on time would mean averting 10 million under-five deaths compared with a business-as-usual scenario. If current trends continue, over 60 million children under 5 years of age will die between 2017 and 2030, about half of which would be newborns. Meeting the SDG target would reduce that number of under-five deaths by 10 million between 2017 and 2030. Urgent efforts are needed in the countries that are falling behind. Many of the countries with low rates of progress are concentrated in sub-Saharan Africa and South Asia.
Accelerating progress to achieve the SDG target on neonatal mortality would save the lives of 5 million newborns from 2017 to 2030. If current trends continue, 60+ countries will miss the SDG target for neonatal mortality by 2030. Based on current trends, 30 million newborns would die between 2017 and 2030. Eighty per cent of these deaths would occur in South Asia and sub-Saharan Africa. About one in six of these deaths (5 million) could be averted if countries at risk of missing the SDG target with low rates of progress and high neonatal mortality rates accelerate progress.
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.
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]