Disparities in child survival

While the under-five mortality rate at national level is a good indicator of levels and trends of child survival for a country as a whole, it often masks disparities between different population groups.

Comparison of under-five mortality between the poorest and richest quintiles of the population shows larger inequalities, with mortality of the poorest quintile more than double that of the richest (see figure 1). This ratio varies from 1.9 for sub-Saharan Africa, which has the highest under-five mortality in the world, to 2.8 for East Asia and the Pacific (excluding China).

Over the last two decades, more countries increased disparity between the richest and the poorest than decreased it, with twice the number of countries in the upper-left quadrant of figure 2 compared to those in the lower left quadrant. The inference is that even though national under-five mortality has been reduced in many countries, disparity between poor and rich has generally increased.

Across developing countries girls have lower under-five mortality than boys because of biological and genetic advantages. However, in a few countries, including the two countries with the largest populations (China and India), these advantages are outweighed by discriminatory practices that result in girls’ having a higher under-five mortality rate than boys.

Under-five mortality is, on average, 50 per cent higher in rural than urban areas, a ratio of 1.5. This ratio varies by region from 1.3 to 1.7 (see figure 3). The children of educated mothers are more likely to survive than children of mothers with no education. While sub-Saharan Africa has the largest absolute difference in under-five mortality by education status, the largest ratio difference occurs in the Latin America and Caribbean region (see figure 4).

It is important to address these disparities in order to achieve MDG 4.

                   Figure 1. Under-five mortality is higher in the poorest households
                           Ratio of under-five mortality rate: the poorest 20% to the richest 20%, by region

Source: Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), Reproductive Health Surveys, mainly 2000–2008 (with further analysis by UNICEF 2010).

Notes: Analysis is based on 68 developing countries with data on the under-five mortality rate by wealth quintile, accounting for 70% of total births in the developing world in 2008. For countries with more than one survey, data from the most recent surveys were used.

The regional average was calculated based on weighted under-five mortality rates. The annual number of births was used as the weight for each country. The country-specific estimates obtained from most household surveys refer to a 10-year period preceding the year of data collection. Because levels or trends may have changed since then, caution should be used in interpreting these results.

CEE/CIS=Central and Eastern Europe/Commonwealth of Independent States.

Eighteen countries among 26 countries with a decline of 10 per cent or more in under-five mortality experienced increasing or stagnant inequality in under-five mortality between the poorest 20 per cent and richest 20 per cent. Of these 18 countries, 10 countries increased inequality in under-five mortality by 10 percentage points or more.

Note: The proportional change of inequality in under-five mortality is measured by the proportional change of the ratio of under-five mortality rate between the poorest 20% and the richest 20% over time. Analysis is based on 38 countries that have at least two DHS and have data on under-five mortality rate by wealth quintiles. Data from the two most recent DHS were used in the calculation for each country. Caution should be used in interpreting these trends since the under-five mortality estimates by wealth quintiles estimated through the DHS surveys included in this analysis refer to a 10-year period preceding the year of data collection. Trends may have changed since then.

              Figure 3. Under-five mortality is higher in rural than in urban areas across all regions
                                               Ratio of under-five mortality rate: rural to urban area, by region
                            

Source: Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), Reproductive Health Surveys, mainly 2000–2008 (with further analysis by UNICEF, 2010).

Notes: Analysis is based on 83 developing countries with data on under-five mortality rate by residence, accounting for 75% of total births in the developing world in 2008. For countries with more than one survey, data from the most recent surveys were used.

The regional average was calculated based on weighted under-five mortality rates. The annual number of births was used as the weight for each country. The country-specific estimates obtained from most household surveys refer to a 10-year period preceding the year of data collection. Because levels or trends may have changed since then, caution should be used in interpreting these results.

                            Figure 4. Children of educated mothers are more likely to survive
                                     Under-five mortality rate (per 1,000 live births) by education of mother, by region

The regional average was calculated based on weighted under-five mortality rates. The annual number of births was used as the weight for each country. The country-specific estimates obtained from most household surveys refer to a 10-year period preceding the year of data collection. Because levels or trends may have changed since then, caution should be used in interpreting these results.