Reduce child mortality
Target 5: Between 1990 and 2015, reduce the under-five mortality rate by two thirds.
Progress
In 2005, over 10 million children died before their fifth birthday. Although a significant number of countries have succeeded in improving the health and wellbeing of babies and children in recent years – the countries with the highest burdens have made the least progress and in some the situation has actually worsened. Progress is increasingly uneven, leaving large disparities between countries as well as between sub-groups within countries.
Unless efforts are increased, there is little hope of eliminating avoidable child deaths. If current trends continue, the MDG will not be achieved until 2045 – 30 years late.
Around 400 million children have no access to safe water. Some 1.4 million children every year - and 3,900 children every day - die because they lack access to safe drinking water and adequate sanitation.
Key messages
- The health and well-being of women and their children are completely linked. There is a strong consensus that maternal, newborn and child health (MNCH) programmes will only be effective if there is a continuum of care, from pregnancy through childbirth into childhood. This continuity requires greatly strengthened health systems with MNCH at their core.
- Of the four million babies that die each year in the first 4 weeks of life (neonatal period), nearly three quarters could be prevented if women were adequately nourished and received appropriate care during pregnancy, childbirth and the postnatal period. Many of the world’s 3.3 million stillbirths could also be saved.
- Most deaths to children under five years are attributable to acute respiratory infections (mostly pneumonia), diarrhoea, malaria, measles, HIV/AIDS and neonatal conditions – which are all avoidable through existing interventions.
- The knowledge and effective interventions for reducing child mortality are available and technically appropriate to the countries and areas that need them most.
- HIV/AIDS is a huge and growing problem for children. In 2006, the estimated number of children under 15 years old living with HIV was 2.3 million – 87% of whom are in sub-Saharan Africa. Furthermore, an estimated to be 15.2 million children have lost one or both parents to AIDS, 80% of them in sub-Saharan Africa. By 2010, the figure is likely to rise to more than 20 million.
- Malnutrition increases the risk of dying from these diseases and over half of all child deaths occur in children who are underweight.
- Malaria is a major cause of anaemia in pregnant women and children, as well as of low birth weight and premature birth. Of the one million malaria deaths each year, more than 90% are among young African children.
- Attention to women’s sexual and reproductive health (SRH) and increasing access to SRH supplies, such as condoms, is also important for child health. For example, untreated syphilis in pregnancy results in a stillbirth rate of 25% and causes 14% of neonatal deaths. In Africa, syphilis prevalence in pregnant women ranges from 4 - 15%.
- Public health measures have a vital role to play in reducing the number of young children dying. But, reducing child mortality will also require actions to improve: nutrition, gender equality, education and household incomes. Any action to improve services must ensure equitable access for the most vulnerable women and children.
- Discrimination against girls and unequal sharing of food and resources within households have a significant impact on child mortality, especially that of girls.
- Globally, the proportion of children under five who are underweight declined by one fifth over the period 1990-2005. However, only modest progress has been seen in Southern Asia and sub-Saharan Africa, where malnutrition continues to combine with major diseases to increase the risks of death for millions of children.
Challenges and solutions
- Most children in developing countries die from preventable causes for which there are known and effective interventions. Many of these interventions can be delivered at the community level, linked to and supported by a well functioning health system, e.g. promoting the use of insecticide treated nets to help prevent malaria and supporting breastfeeding (exclusive and immediate breastfeeding reduces child mortality significantly). Improving water supplies and sanitation are also key to preventing child deaths.
- Without HIV prevention measures, about 35% of children born to HIV infected women will contract the virus. However, in 2005, only 9% of HIV infected pregnant women were offered the services necessary to prevent infection in their newborns. The key to protecting children is preventing infection in parents and improving access to HIV prevention, treatment and care within maternal health services.
- In malaria endemic countries, the use of insecticide treated bed nets has been shown to reduce under five mortality rates by up to 20% – this translates to the prevention of almost half a million deaths each year to children in sub-Saharan Africa.
- Poverty is a considerable barrier to reducing child mortality. Poor families are often unable to obtain even the most basic healthcare for their children. Unsurprisingly, it is also the poor who usually suffer most from food scarcity and lack of access to a safe water source or adequate sanitation. These factors combine to increase the likelihood that children will contract and die from diseases.
- Inadequate population and health statistics make it very difficult to monitor the progress of policies to reduce child mortality. Building monitoring capacity in developing country governments would facilitate better understanding of the number of children dying and from what cause, and to assess which interventions are making a difference.
Facts and figures
- Worldwide, nearly 28,000 children under five die every day – that is one every 3 seconds. Most of these deaths could have been prevented. Four million newborns die in the first 4 weeks of life, three million of those in the first week. A further 3.3 million babies are stillborn.
- One in six babies born in the world’s least developed countries will die before the age of five, compared with one in 167 born in industrialised countries.
- In 2003, over 27 million children missed out on immunization during their first year of life – leaving them vulnerable to infectious diseases both in childhood and during their productive adult years.
- Countries that have adopted well-known and effective anti-measles strategies, including Botswana, Malawi, South Africa and Namibia, have reduced measles deaths to near zero since 2000. Globally, deaths from measles fell by over 60% between 2000 and 2005. The number of these deaths dropped from 873,000 in 1999 to 345,000 in 2005. The most striking gains were found in Africa, where measles deaths decreased by nearly 75% over the same period – from an estimated 506,000 to 126,000.
- Of the 12 countries where more than 20% of children die before their 5th birthday, 9 have suffered a major armed conflict in the last 5 years.
- 270 million of the world’s children (about one in seven) have no access to healthcare.
- Although many countries in sub-Saharan Africa saw little or no decline in child mortality (and in some cases even saw increases), there have been some notable success stories, including Benin, Botswana, Cameroon and more recently Malawi, Mozambique and Tanzania.
- There is a clear relationship between child mortality and poverty – the poorer people are, the more likely their children will die. Children in the wealthiest 20% of households are twice as likely to survive as those in the poorest 20%. Those mothers that have at least secondary education are twice as likely to survive as those whose mothers are less educated.
- There are 60 million fewer women in the world than demographic trends have forecast, meaning that at least 60 million girls, who would otherwise be alive are missing, mainly from Asian populations, due to sex-selective abortion, female infanticide, neglect and inferior access to food and medicine.
- In malaria endemic countries, the use of insecticide treated bed nets has been shown to reduce under five mortality rates by up to 20% – this translates to the prevention of almost half a million deaths each year to children in sub-Saharan Africa.
- Poverty is a considerable barrier to reducing child mortality. Poor families are often unable to obtain even the most basic healthcare for their children. Unsurprisingly, it is also the poor who usually suffer most from food scarcity and lack of access to a safe water source or adequate sanitation. These factors combine to increase the likelihood that children will contract and die from diseases.
- Inadequate population and health statistics make it very difficult to monitor the progress of policies to reduce child mortality. Building monitoring capacity in developing country governments would facilitate better understanding of the number of children dying and from what cause, and to assess which interventions are making a difference.
What the UK government is doing to help
At the country level, DFID is supporting child health through our work to strengthen health systems to deliver better health services. Globally, DFID makes significant financial contributions to the UN Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the World Bank, the World Health Organisation (WHO), the Partnership for Maternal, Newborn and Child Health and other international and national civil society groups, to support their efforts to improve both maternal and child health.
DFID contributes to global initiatives such as the Global Fund to Fight AIDS, TB and Malaria, the Global Alliance for Vaccines and Immunization and Roll Back Malaria. These initiatives have helped both to revitalise interest in childhood diseases and increase the resources directed to child health.
DFID works with the International Finance Facility for Immunisation (IFFIm) to accelerate the availability of funds to be used for health and immunisation programmes through the GAVI Alliance in 70 of the poorest countries. The GAVI Alliance has members including developing country and donor governments, WHO, UNICEF, the World Bank, the vaccine industry, research and technical agencies, NGOs, the Bill & Melinda Gates Foundation and the GAVI Fund. IFFIm is a new international development financing institution that is supported by the governments of France, Italy, Norway, South Africa, Spain, Sweden and the United Kingdom.
DFID is a key partner in the Norwegian government’s drive to achieve MDGs 4 and 5 – and specifically in helping Norad to draw up a Global Business Plan for tackling maternal and child deaths.
DFID has supported the Management of Childhood Illness Initiative with UNICEF, the WHO, the World Bank and USAID. The initiative aims to increase the quality and quantity of child healthcare available within countries.
We also support the work of the Health Metrics Network to help countries to provide better data to track their progress towards MDG 4. This includes supporting progress towards better registration of births and deaths, improved estimation of child death rates from surveys and censuses and supporting the development of indicators to better measure improvements in health and health systems.
Sources
- UN Statistics Division: The Millennium Development Goals Report (2007)
- UNICEF: State of the World’s Children – Excluded and Invisible (2006)
- WHO: World Health Report – Make Every Mother and Child Count (2005)
- UNICEF: State of the World’s Children’s – Childhood under Threat (2005)
- UNAIDS: Report on the Global Aids Epidemic (2006)
- WHO Prevention and control of sexually transmitted infections – global strategy 2006-2015 (May 2006)
- The Lancet: Neonatal Survival Series (March 2005)
- UN Statistics Division: Progress towards the MDGs 1990-2005: Report on MDG 4 (2005)
- UNICEF: State of the World’s Children – Women and Children – The Double Dividend of Gender Equality (2007)
- United Nations Millennium Development Goal Report (2006)
- UNFPA: State of the World Population – Ending Violence Against Women and Girls (2000)
- UNICEF: Facts for Life: Breastfeeding
- UNAIDS: AIDS Epidemic Update (December 2005)
- United Nations: Declaration of Commitment on HIV/AIDS: Five years later SG’s report to the 60th Session of the UN item 45 (March 2006)
- BM: Roll Back Malaria Info Sheet – Children and Malaria (2006)
- DFID: Departmental Report (2006)
- World Bank – An impact evaluation of interventions to improve maternal and child health and nutrition in Bangladesh (2005)
- WHO: Immunization against diseases of public health importance (2005)