It has been 13 years since world leaders committed to Millennium Development Goal 4 (MDG 4), which sets out to reduce the under-five mortality rate by two-thirds between 1990 and 2015. The world has made substantial progress, reducing the under-five mortality rate from 90 (89, 92) deaths per 1,000 live births in 1990 to 48 (46, 51) in 2012. Correspondingly, the global number of under-five deaths has dropped from 12.6 (12.4, 12.9) million in 1990 to 6.6 (6.3, 7.0) million in 2012.
Figure 1. The global burden of under-five deaths has fallen steadily since 1990
Global under-five deaths, millions, 1990-2012
Since 1990 the global under-five mortality rate has dropped 47 percent—from 90 (89, 92) deaths per 1,000 live births in 1990 to 48 (46, 51) in 2012. This is a substantial achievement, but acceleration is needed to reach the MDG 4 target of 30 deaths per 1,000 live births by 2015.
Figure 2. The global under-five mortality rate has almost halved since 1990
Global under-five, infant and neonatal mortality rates, 1990-2012
At the regional level, there has been substantial progress. With the exception of west and central Africa and sub-Saharan Africa as a whole, every world region has at least halved its under-five mortality rate. East Asia and the Pacific and Latin America and the Caribbean are both on-track to complete MDG 4 at the regional level.
Figure 3. Since 1990, every world region has seen a decline in under-five mortality rates
Under-five deaths per 1,000 live births, by UNICEF region, 1990 and 2012
While the global number of under-five deaths has dropped since 1990, this still translates into nearly 18,000 children dying every day in 2012. Infectious diseases (such as pneumonia, diarrhoea and malaria), undernutrition and neonatal complications are responsible for the vast majority of under-five deaths — nearly all of which are preventable.
Figure 4. Almost two thirds of all under-five deaths are the result of infectious diseases and conditions
Global distribution of deaths among children under age five, by cause, 2012
Source: CHERG 2013
Accelerating progress in child survival urgently requires greater attention to ending preventable child deaths in sub-Saharan Africa and South Asia, which together account for 4 out of 5 under-five deaths globally. South Asia has made strong progress on reducing preventable deaths, more than halving its number of deaths among children under 5 since 1990. Sub-Saharan Africa, however, continues to lag behind, having only decreased its under-five mortality by 45% since 1990. However, along with the Middle East and North Africa, it is one of only two regions that have experienced a consistent acceleration in the pace of reducing under-five mortality rates since 1990.
Figure 5. Annual rates of reduction have accelerated consistently in Sub-Saharan Africa
Annual rates of reduction in under-five mortality, by UNICEF region, 2012
The significance of sub-Saharan Africa in particular cannot be ignored: Its under-five mortality of 98 deaths per 1,000 live births is higher than any other region. In addition, by mid-century it will be the region with the single biggest population of children under five, accounting for 37% of the global total and close to 40% of all live births.
Figure 6. Countries with high under-five mortality are concentrated in sub-Saharan Africa and south Asia
Under-five deaths per 1,000 live births, 2012
Of the 61 high-mortality countries with at least 40 deaths per 1,000 live births in 2012, 25 managed to at least halve their under-five mortality rates between 1990 and 2012 — with seven (Bangladesh, Ethiopia, Liberia, Malawi, Nepal, United Republic of Tanzania and Timor-Leste) having already reduced the under-five mortality rate by two-thirds or more.
Figure 7. Some high mortality countries have had great success in decreasing child mortality
High-mortality countries* with greatest percentage declines (= 50%) in under-five mortality rate from 1990-2012
The annual rate of reduction in the under-five mortality rate has accelerated since 1995 at all country income levels except high-income countries (Figure 12). Gains in low- and middle-income countries in particular have been substantial. And although there is a link between a country’s level of income and its child mortality, the strong reductions in the under-five mortality rate in a few low-income countries since 1990 and particularly since 2000 prove that low income need not be an impediment to saving children’s lives.
Figure 8. Many low income countries have made significant progress in reducing child deaths
Decline in under-five mortality rate, 1990-2012 and GDP per capita in 2012
The world has made great strides since 1990; however, an accelerated rate of progress is still called for as the deadline of 2015 to meet the MDG target approaches. Going beyond 2015, the momentum to improve child survival must be sustained in all regions. Since 1990, 90 million lives have been saved by decreases in child mortality worldwide, but many more lives can be saved. In order to meet MDG 4, an additional 3.5 million children’s lives must be saved by 2015. If current trends continue, the world will not meet the MDG 4 target until 2028.
Figure 9. Declines in under-five mortality have saved millions of lives worldwide
Under-five mortality rate, 1990-2012 and projected 2013-2028
Footnote: * Countries with an under-five mortality rate of 40 or more deaths per 1,000 live births in 2012.
UNICEF analysis based on IGME 2013, drawing on provisional analyses by WHO and Child Health Epidemiology Reference Group (CHERG) 2013. References: Liu, Li, et al., ‘Global, Regional, and National Causes of Child Mortality: An updated systematic analysis for 2010 with time trends since 2000’, The Lancet, vol. 379, no. 9832, 9 June 2012, pp. 2151–2161. World Health Organization, ‘WHO-CHERG methods and data sources for child causes of death 2000-2011’, Global Health Estimates Technical Paper WHO/HIS/HSI/GHE/2013.2, WHO Geneva, available at
The UN Inter-agency Group for Child Mortality Estimation (IGME), Levels and Trends in Child Mortality: Report 2013, UNICEF, New York, 2013.
UNICEF, Committing to Child Survival: A Promise Renewed – Progress Report 2013, New York, 2013.