Neonatal mortality, covering deaths in the first month after birth, is of interest because the health interventions needed to address the major causes of neonatal deaths generally differ from those needed to address other under-five deaths.
Neonatal mortality is increasingly important because the proportion of under-five deaths that occur during the neonatal period is increasing as under-five mortality declines. Because declines in the neonatal mortality rate are slower than those in the mortality rate for older children, worldwide, the share of neonatal deaths among under-five deaths increased from about 36 percent in 1990 to about 43 percent in 2011, and the trend is expected to continue. While the relative increase is modest (17 percent) at the global level, there are differences across regions. The largest increase has been in East Asia and Pacific (28 percent); the smallest in Central and Eastern Europe and the Commonwealth of Independent States (19 percent).
All regions are experiencing slower declines in neonatal mortality than in under-five mortality. Over the last 22 years all regions have seen slower reductions in neonatal mortality than in under-five mortality. Globally, neonatal mortality has declined 32 percent, from 32 deaths per 1,000 live births in 1990 to 22 in 2011—an average of 1.8 percent a year, much slower than for under-five mortality (2.5 percent per year). The fastest reduction was in Latin America and the Carribbean (55 percent), followed by East Asia and Pacific (54 percent); the slowest in Sub-Saharan Africa (24 percent).
More than half the under-five deaths in East Asia and Pacific, Latin America and the Caribbean, and Southern Asia are neonatal deaths. In both Latin America and the Caribbean and East Asia and Pacific, the regions with the largest reductions in under-five mortality, neonatal deaths accounted for 53% of under-five deaths in 2011. Both regions will have to scale up health interventions that tackle neonatal mortality in order to continue their success in reducing under-five mortality. Southern Asia also needs to address neonatal mortality: neonatal deaths account for 52% of under-five deaths, and almost 30 percent of global neonatal deaths occurred in India. Sub-Saharan Africa, which accounts for 33 percent of global neonatal deaths, has the highest neonatal mortality rate (34 deaths per 1,000 live births in 2011) and is the region that have shown the least progress in reducing that rate over the last two decades. Neonatal deaths there account for about a third of under-five deaths (1.1 million neonatal deaths), and greater emphasis should be on reducing both these deaths and other important causes of under-five deaths.
With the proportion of under-five deaths during the neonatal period increasing in every region and almost all countries, systematic action is required by governments and partners to reach women and babies with effective care. Highly cost-effective interventions are feasible even at the community level, and most can be linked with preventive and curative interventions for mothers and for babies. For example, early postnatal home visits are effective in promoting healthy behaviours such as breastfeeding and clean cord care as well as in reaching new mothers. Case management of neonatal infections can be provided alongside treatment of childhood pneumonia, diarrhoea and malaria. Care at birth brings a triple return on investment, preventing stillbirths and saving mothers and newborns.
Figure 1. Neonatal mortality declined in all regions
Decline (percent) in neonatal mortality rate, by UNICEF region, 1990 to 2011
Figure 2. The share of neonatal deaths among under-five deaths has increased in all regions
Proportion of under-five deaths occur in neonatal period (percent), by UNICEF region, 1990 and 2011
Table 1. Neonatal mortality rate, number of neonatal deaths and neonatal deaths as a share of under-five deaths, by UNICEF region, 1990 and 2011
|UNICEF Region||Neonatal mortality rate (deaths per 1,000 live births)||Number of neonatal deaths (thousands)||Neonatal deaths as a share of under-five deaths (percent)|
|1990||2011||Decline (percent) 1990-2011||1990||2011||1990||2011||Relative increase (percent) 1990-2011|
|Eastern and Southern Africa||43||29||32||456||429||27||36||33|
|West and Central Africa||48||39||18||530||658||26||31||22|
|Middle East and North Africa||27||16||39||244||158||37||45||21|
|East Asia and Pacific||24||11||54||895||312||41||53||28|
|Latin America and the Caribbean||22||10||55||256||107||42||53||26|
|CEE / CIS||19||10||50||136||57||38||45||19|
The UN Inter-agency Group for Child Mortality Estimation (IGME), Levels and Trends in Child Mortality: Report 2012, UNICEF, New York, 2012.
UNICEF, Committing to Child Survival: A Promise Renewed – Progress Report 2012, New York, 2012.