Reduction in the infant and under-five mortality rate by at least one third, in pursuit of the goal of reducing it by two thirds by 2015	Reduce child mortality. Target: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate

The challenge

In 2008, 8.8 million children born alive across the world died before their fifth birthday. Most of these children lived in developing countries and died from a disease or a combination of diseases that could easily have been prevented or treated – antibiotics for pneumonia, for example, or a simple mix of water, salt and sugar for diarrhoea. Undernutrition contributes to over a third of these deaths.
 
According to the new estimates generated by the Inter-agency Group for Child Mortality Estimation (IGME), overall, substantial progress has been made towards the achievement of MDG 4. In 2008, 10 000 fewer children under age five are dying every day than in 1990, the baseline year for the MDGs. Moreover, the rate of decline in under-five mortality increased for the period 2000 to 2008 compared with the 1990s (the average annual rate of decline for 2000–08 is 2.3% compared with 1.4% for 1990–2000).

However, the rate of decline in under-five mortality is still grossly insufficient to obtain the MDG goal by 2015, particularly in sub-Saharan Africa and South Asia, and it is alarming that among the 67 countries with high mortality rates (40 per 1000 or more), only ten are on track to meet MDG 4. 
 

                             Under-five mortality rates declined between 1990 and 2008     

In addition, under-five mortality is increasingly concentrated: 75% of the world’s under-5 deaths in 2008 occurred in only 18 countries. Half of the deaths occurred in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China. And India and Nigeria together account for nearly one-third of the total number of under-5 deaths worldwide (21% and 12%, respectively). Africa and Asia combined represent 93% of all under-5 deaths (51% and 42%, respectively).

The sum of the number of deaths by region is not equal to 8.8 million due to rounding. CEE/CIS=Central and Eastern Europe/Commonwealth of Independent States.                       

Child mortality is closely linked to poverty. Advances in infant and child survival have come more slowly in poor countries and to the poorest people in wealthier countries. Improvements in public health services are essential, including safe water and better sanitation. Education, especially for girls and mothers, will also save children's lives. Raising income can help, but little will be achieved unless a greater effort is made to ensure that services reach those who need them most. 

Under-five mortality rate (U5MR) and under-five deaths: levels and trends, 1990-2008

Under-five mortality rate (per 1000 live births)

Child mortality is higher among children living in rural areas and in the poorest households
Under-five mortality rate (per 1,000 live births) by background characteristics (1998–2006)

                                                 

To meet MDG 4 calls for a more concerted effort to accelerate progress, which will require a combination of different strategies. First, in addition to the countries with the highest mortality rates, a renewed focus on high-burden countries with the greatest number of deaths is required. Achieving faster progress in these countries, including India, Nigeria, Democratic Republic of the Congo, Pakistan, and China (which make up nearly 50% of all under-5 deaths), will be crucial in accelerating progress toward meeting MDG 4 at the global level. Second, review of the countries with the highest absolute levels of under-5 mortality or of those making the least progress since 1990, shows that countries in conflict or in transition are significantly over-represented. More analytical work needs to be done to document and disseminate best practices in such countries for achieving improvements in child survival. Additionally, the donor community should support these countries by prioritising them in new initiatives, such as the International Health Partnerships9 or through resources from global funds, and by supporting implementing UN agencies and non-governmental organisations to develop innovative programming models.

Source for figures: UNICEF estimates based on the work of the Inter-agency Child Mortality Estimation Group. Disparity analysis based on household survey data (MICS and DHS) collected in 63 developing countries during 2000-2006.

References

D. You, T. Wardlaw, P. Salama, G. Jones, Levels and trends in under-5 mortality, 1990–2008, The Lancet, 2009

UNICEF, The State of the World’s Children - Special Edition, Celebrating 20 Years of the Convention on the Rights of the Child (Forthcoming)