Under-five mortality
Only four years remain to achieve Millennium Development Goal 4 (MDG 4), which calls for reducing the under-five mortality rate by two-thirds between 1990 and 2015. Since 1990 the under-five mortality rate has dropped 35 percent, with every developing region seeing at least a 30 percent reduction. However, at the global level progress is behind schedule. The global under-five mortality rate needs to be halved from 57 deaths per 1,000 live births to 29that implies an average rate of reduction of 13.5 percent a year, much higher than the 2.2 percent a year achieved between 19902010.
Figure 1: All regions have reduced under-five mortality rates
Under-five mortality rate (per 1,000 live births), 1990-2010, by UNICEF region
According to the latest estimates generated by the Inter-agency Group for Child Mortality Estimation, overall, substantial progress has been made towards achieving MDG 4. The total number of under-five deaths in the world has declined from more than 12 million in 1990 to 7.6 million in 2010. About 12,000 fewer children died every day in 2010 than in 1990, the baseline year for measuring progress. Improvement in child survival is evident in all regions. Three of six developing regions (Sub-Saharan Africa, South Asia, Middle East and North Africa, East Asia and Pacific, Latin America and Caribbean, and CEE/CIS) show reductions in under-five mortality of more than 50 percent over 19902010(figure 2). The number of countries with under-five mortality rates of 100 deaths per 1,000 live births or higher has been halved from 52 in 1990 to 26 in 2010. In addition, no country had an under-five mortality rate above 200 deaths per 1,000 live births in 2010, compared with 13 in 1990. The rate of decline has accelerated from 1.9 percent a year over 19902000 to 2.5 percent a year over 20002010. Moreover, in Sub-Saharan Africa, the region with the greatest burden of under-five deaths, the rate of decline doubled.
Table 1: Under-five mortality rate, by UNICEF region, 1990-2010
| UNICEF Region | 1990 | 1995 | 2000 | 2005 | 2007 | 2008 | 2009 | 2010 | Decline 1990-2010 (%) | Average annual rate of reduction 1990-2010 (%) | Progress towards the MDG target 2010 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| AFRICA | 160 | 155 | 142 | 127 | 121 | 117 | 114 | 111 | 31 | 1.8 | Insufficient progress |
| Sub-Saharan Africa | 174 | 168 | 154 | 138 | 131 | 128 | 124 | 121 | 30 | 1.8 | Insufficient progress |
| Eastern and Southern Africa | 156 | 151 | 137 | 118 | 110 | 105 | 101 | 98 | 37 | 2.3 | Insufficient progress |
| West and Central Africa | 196 | 189 | 175 | 159 | 152 | 149 | 146 | 143 | 27 | 1.6 | Insufficient progress |
| Middle East and North Africa | 77 | 65 | 55 | 48 | 45 | 44 | 42 | 41 | 47 | 3.2 | Insufficient progress |
| ASIA | 86 | 77 | 65 | 56 | 52 | 51 | 49 | 48 | 44 | 2.9 | Insufficient progress |
| South Asia | 120 | 104 | 89 | 76 | 72 | 71 | 69 | 67 | 44 | 2.9 | Insufficient progress |
| East Asia and Pacific | 55 | 48 | 38 | 31 | 28 | 26 | 25 | 24 | 56 | 4.1 | On track |
| Latin America and Caribbean | 54 | 44 | 35 | 27 | 24 | 23 | 22 | 23 | 57 | 4.3 | On track |
| Central and Eastern Europe / Commonwealth of Independent States | 50 | 48 | 37 | 29 | 26 | 25 | 24 | 23 | 54 | 3.9 | On track |
| Industrialized countries | 10 | 8 | 7 | 6 | 6 | 6 | 6 | 6 | 40 | 2.6 | On track |
| Developing countries | 97 | 90 | 80 | 71 | 68 | 66 | 64 | 63 | 35 | 2.2 | Insufficient progress |
| Least developed countries | 170 | 155 | 138 | 123 | 117 | 114 | 112 | 110 | 35 | 2.2 | Insufficient progress |
| World | 88 | 82 | 73 | 65 | 61 | 60 | 58 | 57 | 35 | 2.2 | Insufficient progress |
Table 2: Number of under-five deaths, by UNICEF region, 1990-2010
| UNICEF Region | 1990 | 1995 | 2000 | 2005 | 2009 | 2010 | Decline 1990-2010 (%) | Proportion of under-five deaths worldwide in 2010 (%) |
|---|---|---|---|---|---|---|---|---|
| AFRICA | 4,038 | 4,187 | 4,159 | 4,077 | 3,852 | 3,804 | 6 | 50 |
| Sub-Saharan Africa | 3,734 | 3,977 | 4,006 | 3,956 | 3,752 | 3,709 | 1 | 49 |
| Eastern and Southern Africa | 1,559 | 1,629 | 1,617 | 1,517 | 1,355 | 1,322 | 15 | 17 |
| West and Central Africa | 2,046 | 2,211 | 2,246 | 2,293 | 2,252 | 2,241 | -10 | 29 |
| Middle East and North Africa | 718 | 577 | 496 | 446 | 423 | 415 | 42 | 5 |
| ASIA | 6,575 | 5,411 | 4,546 | 3,680 | 3,282 | 3,186 | 52 | 42 |
| South Asia | 4,399 | 3,856 | 3,297 | 2,789 | 2,552 | 2,492 | 43 | 33 |
| East Asia and Pacific | 2,175 | 1,556 | 1,249 | 890 | 731 | 694 | 68 | 9 |
| Latin America and Caribbean | 623 | 511 | 397 | 305 | 237 | 249 | 60 | 3 |
| Central and Eastern Europe / Commonwealth of Independent States | 371 | 269 | 200 | 156 | 141 | 136 | 63 | 2 |
| Industrialized countries | 118 | 93 | 73 | 70 | 66 | 65 | 45 | 1 |
| Developing countries | 11,784 | 10,551 | 9,447 | 8,355 | 7,655 | 7,516 | 36 | 99 |
| Least developed countries | 3,497 | 3,503 | 3,338 | 3,174 | 2,965 | 2,949 | 16 | 39 |
| World | 12,010 | 10,702 | 9,575 | 8,467 | 7,756 | 7,614 | 37 | 100 |
Figure 2: Globally, 7.6 million children died before reaching their fifth birthday in 2010
Under-five deaths (thousands), 2010
But these rates are still insufficient to achieve MDG 4 by 2015: only 3 of 6 developing regions are on track to achieve the MDG 4. Of the 66 countries with at least 40 deaths per 1,000 live births in 2010, only 11 are on track to achieve MDG 4.
Figure 3: Many countries were on track in 2010 to reach MDG 4, but progress needs to accelerate in Sub-Saharan Africa and South Asia
Note: Data for Sudan refer to the country as it was constituted in 2010, before South Sudan Seceded on 9 Juy 2011.
As under-five mortality rates have fallen more sharply in richer developing countries, the disparity between Sub-Saharan Africa and other regions has grown. In 1990 a child born in Sub-Saharan Africa faced a probability of dying before age 5 that was 1.4 times higher than in South Asia, 3.2 times higher than in Latin America and the Caribbean, and 17.4 times higher than in industrialized countries. By 2010 that probability was 1.8 times higher than in South Asia, 5.1 times higher than in Latin America and the Caribbean, and 20.1 times higher than in industrialized countries. The disparity between South Asia and richer regions has also grown, though not as much.
A major reason for the limited progress in reducing child mortality at the global level, despite half the regions having already achieved reductions of more than 50 percent, is the large and growing share of under-five deaths that occur in Sub-Saharan Africa and South Asia (80 percent). Of the 26 countries with under-five mortality rates above 100 deaths per 1,000 live births in 2010, 24 are in Sub-Saharan Africa. Thus, to achieve MDG 4, substantial progress is needed in both regions.
That 9 of the 14 best-performing countries are from Sub-Saharan Africa and South Asia, the two regions most in need of a faster reduction of the under-five mortality rate, shows that substantial progress can be made in these regions. There is increasing evidence that MDG4 can be achieved, but only if countries in Sub-Saharan Africa and South Asia give high priority to reducing child mortality, particularly by targeting the major killers of children (including pneumonia, diarrhoea, malaria and undernutrition)with effective preventative and curative interventions.