Reducing Child Mortality 

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Millennium Development Goal 4: Reduce child mortality

• Target 5: Between 1990 and 2015, reduce the under-five mortality rate by two thirds.

Key Messages

• Thirty years ago, one in five children in the world died before their fifth birthday. This has now been halved to less than one in ten. Better access to vaccinations and other basic health services and improved living standards have contributed to a steep decline in global deaths among infants and children over the past 30 years.
• But progress varies both from country to country and within countries as well. In some parts of the world, particularly in sub-Saharan Africa, these declines in the rates of child death are slowing down or even being reversed.
• Public health measures have a vital role to play in reducing the number of young children dying. Action  needs to be taken to improve: nutrition, gender inequality, education and household incomes, hygiene and access to safe water and sanitation.

Facts and figures

• Nearly 11 million under-fives are dying every year. Most of them are living in developing countries, with more than four million of these deaths in sub-Saharan Africa.
• In sub-Saharan Africa, child mortality rates are running at an average rate of 172 deaths per 1000 babies born, compared with 9 per 1000 in developed regions. The statistics are generally the worst in countries that are in or emerging from conflict.
• Major causes of death for under-fives in sub-Saharan Africa include malaria, acute respiratory infections, diarrhoea and AIDS. Additionally, many babies die in the first month of life due to complications in their mother’s pregnancy and labour or from infections.
• Recent estimates suggest that nearly two-thirds of these deaths in children under five could be prevented by all children having access to a few known and effective interventions, basic services, clean water and sanitation.
• Around 80% of the children dying in Africa die at home without seeing a health care provider.
• Each year, four million babies die within their first month of life, accounting for up to 40% of deaths of children under five. Improved maternal health in pregnancy and labour could prevent up to 70% of these neonatal deaths.
• Wider gaps between births and preventing pregnancies in very young women could reduce child mortality by up to a quarter.
• There are more than 600,000 new cases of HIV in children each year. In most cases the infection is passed to them from their mother in utero or through breastfeeding.
• In Africa, at least 24 million pregnancies are threatened by malaria each year. Pregnant women are more susceptible to malaria infection than non-pregnant women. Malaria affects both the mother and the foetus. Malaria causes low birth weight - mortality in these infants is four times higher than in normal birth weight infants.
• Severely malnourished children are eight times more likely to die before their fifth birthday as those who are well nourished. Malnutrition is a contributing factor in around half of all child deaths.

Are we on track to meet the target?

Globally, progress towards the MDG target is uneven. Latest United Nations reports suggest considerable variation between regions in the rates of progress being made towards the under-five mortality target. Latin America and the Caribbean are expected to meet the target, but there has been much slower progress in South Asia, and virtually no progress in sub-Saharan Africa, which accounts for over half of all under-five deaths.

Without more action globally, the international and national death rate for under-fives will only have fallen by one quarter worldwide by 2015.

Obstacles to improvement

Challenges to making faster progress include:

• The HIV and AIDS epidemic.
• Economic decline, conflict, inequality, and persistent poverty in some parts of the world.
• Under-resourced health services many of which don’t have enough health workers or supplies.
• Lack of progress in reducing the number of deaths of newborn babies.

Most children in developing countries die from preventable causes such as diarrhoea, pneumonia, malaria, measles, AIDS and other illnesses and complications that can be fatal to newborns in their first month of life. Undernutrition is a factor in many of these deaths.

Although there are no quick fixes, for each one of these causes of death there is at least one proven way of preventing the disease and at least one proven way of treating it. Unfortunately, too few children have access to them.

More investment in health services, infrastructure and education is required to cut the numbers of young children dying from preventable diseases. Health services need to be affordable, accessible, accountable and appropriate and have enough trained staff and medicines.

Child mortality is also affected by: poor nutrition; access to good sanitation and clean water; the mother’s health and level of education; the child’s gender; and the family’s income. That’s why households and communities need to be at the centre of efforts to make better progress.

Finally poor population and health statistics have made it difficult to monitor progress. In turn, this has made it very difficult to calculate the number of children dying or determine what interventions are making a difference.

Progress - What DFID is doing to help

DFID is involved in a number of initiatives aimed at reducing child mortality.

At the country level, one of the ways DFID is supporting child health is through its work to strengthen health systems to deliver better health services. 

In addition to country-level work, DFID makes significant financial contributions to the UN Population Fund (UNFPA), UNICEF, the World Bank, the World Health Organisation 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. All of these initiatives have helped revitalise interest in childhood diseases and substantially increased the resources directed to child health (see the HIV, TB and Malaria factsheets for more information: http://www.dfid.gov.uk/mdg/hivaids.asp ).

DFID is supporting the implementation of the Integrated Management of Childhood Illness Initiative with partners from the United Nations International Children’s Fund, the World Health Organisation, the World Bank and the United States Agency for International Development. This initiative is building the quality and quantity of child healthcare within countries.

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