Through some noticeable efforts toward sustainable child survival, the world has rightly recognized and moved towards full enjoyment of the right of every child to survive. Yet, in 2021, five million children globally did not reach the age of five, revealing persistent challenges in child survival. Tragically, 2.3 million infants succumbed within their first month, with an additional 2.7 million under-five deaths, heavily concentrated in sub-Saharan Africa and Southern Asia. These stark figures emphasize the profound impact of geographic and economic inequalities, posing a significant threat to achieving SDG target 3.2 on under-five mortality by 2030.
Neonatal mortality
The neonatal mortality rate refers to the probability a newborn would die during the first 28 days of life, expressed per 1,000 live births (Neonatal mortality, UNICEF, 2023). The first 28 days of life – the neonatal period – is the most vulnerable time for a child’s survival. In comparison, the probability of dying after the first month and before reaching age 1 was estimated at 11 deaths per 1,000 and the probability of dying after reaching age 1 and before reaching age 5 was estimated at 10 deaths per 1,000 in 2021 (Child Mortality Report, 2022).
Globally, 2.3 million children died in the first month of life in 2021 (approximately 6,400 neonatal deaths every day). Despite a declining neonatal mortality rate globally (the average global rate declined by 51 percent, from 37 deaths per 1,000 live births in 1990 to 18 in 2021), marked disparities in neonatal mortality exist across regions and countries.
Regionally, neonatal mortality was highest in sub-Saharan Africa and South Asia, with the neonatal mortality rate estimated at 27 and 23 deaths per 1,000 live births, respectively, in 2021. A child born in sub-Saharan Africa was over ten times more likely to die in the first month than a child born in a high-income country, while a child born in South Asia was nine times more likely to die. (Child Mortality Report, 2022).
Under-five mortality
The under-five mortality rate refers to the probability a newborn would die before reaching exactly five years of age, expressed per 1,000 live births (Child Mortality Report, 2022). In 2021, five million children under five years of age died (UNICEF, Under-five mortality, 2023). Over half of these deaths (2.7 million) occurred among children aged 1–59 months, while the remainder (2.3 million) occurred in just the first month of life (Child Mortality Report, 2022).
Children born in low-income countries are more likely to die before reaching age five. According to the 2021 data on infant mortality, children born in low-income countries were 14 times more likely to die before reaching age five than children born in high-income countries (Child Mortality Report, 2022).
The world made remarkable progress in child survival in the past three decades. The global under-five mortality rate has declined by 59 percent, from 93 deaths per 1,000 live births in 1990 to 38 in 2021. Moreover, progress in reducing child mortality rates has been accelerated in the 2000s period compared with the 1990s, with the annual rate of reduction in the global under-five mortality rate increasing from 1.8 percent in 1990s to 4.0 percent for 2000-2009 and 2.7 percent for 2010-2021 (UNICEF, Under-five mortality, 2023).
Most regions in the world and 162 out of 200 countries have at least halved their under-five mortality rate since 1990. Among all countries, 46 percent (92) cut their under-five mortality by at least two-thirds over this same period – 39 of them are low- or lower-middle-income countries, indicating that, while the burden of child mortality is unevenly distributed throughout the world, improving child survival is possible even in resource-constrained settings.
Mortality among children, adolescents and youth (5-24 years)
Close to one million adolescents died in 2021 and globally, about 43 percent of deaths among those aged 5–24 years occurred among adolescents. Across all regions, the probability of dying between the ages of 5 and 24 is lower than for children under 5 years old. At 17 deaths per 1,000 children aged 5 years in 2021, the probability of dying among children and youth aged 5–24 years was about half the level of global under-five mortality even though exposure to the risk of death is four times higher among the older age group (Child Mortality Report, 2022).
From 1990 until 2021, the mortality rate for children and youth aged 5-24 dropped by 46 percent, from 31 to 17 deaths per 1,000 children aged 5, while adolescent mortality declined by 43 percent over the same period, from 13 to 7 deaths per 1,000 adolescents aged 10 (Child and youth mortality data ages 5-24, UNICEF, 2023).
Survival chances for children, adolescents and youth aged 5–24 years vary considerably by region and country. Sub-Saharan Africa and Central and Southern Asia confirm their negative trend also in this field. For instance, over 70 percent of all deaths among 5–24-year-olds occurred in sub-Saharan Africa (46 percent) and Central and Southern Asia (24 percent). If current trends continue, nearly 19 million children, adolescents and youth aged 5–24 years are estimated to die between 2022 and 2030, with more than 70 percent of those deaths projected to take place in just two regions (Child Mortality Report, 2022).
Causes of infant mortality
Most neonatal deaths (75 percent) occur during the first week of life, and in 2019, about 1 million newborns died within the first 24 hours. Preterm birth, childbirth-related complications (birth asphyxia or lack of breathing at birth), infections and birth defects caused most neonatal deaths in 2019. From the end of the neonatal period and through the first 5 years of life, the main causes of death are pneumonia, diarrhoea, birth defects and malaria (Newborn Mortality, WHO, 2022).
Malnourished children, particularly those with severe acute malnutrition, have a higher risk of death from common childhood illnesses such as diarrhoea, pneumonia and malaria. Nutrition-related factors contribute to about 45 percent of deaths in children under 5 years of age (Child mortality under 5 years, WHO, 2022).
Conflict and emergencies – including the COVID-19 pandemic – continue to threaten the survival of children. The under-five mortality rate in the 37 countries classified as fragile and conflict-affected situations was triple the rate when compared to all other countries. While available data on the impact of COVID-19 show no systematic evidence of excess child mortality, this area requires continued monitoring given limited data and the pandemic’s potential impact on access to health care and intervention provision (Child Mortality Report, 2022).
The patterns of death in older children and young adolescents reflect the underlying risk profiles of the age groups, with a shift away from infectious diseases of childhood and towards accidents and injuries (including road traffic injuries, drowning, burns, and falls), self-harm and interpersonal violence which rank among the top causes of death and lifelong disability among children aged 5-14 years (Mortality among children aged 5-14 years, WHO, 2019). Sex differences in mortality rates become apparent in adolescence with rates being higher for males who are confronted with the conditions mentioned above along with collective violence and legal intervention (Older adolescent, WHO, 2022).
Geographic and economic disparities are the drivers of child mortality
One of the most significant hurdles children continue to face are widespread regional and income disparities, both of which have an impact on their survival. Data shows that more than 80 percent of child deaths occur in just two regions: sub-Saharan Africa and Southern Asia. Sub-Saharan Africa continues to be the region with the highest under-five mortality rate (73 deaths per 1,000 live births).
In 2021, 1 in 14 children in sub-Saharan Africa died before reaching their fifth birthday—15 times higher than the risk for children born in high-income countries and 20 years behind the world average, which achieved a 1 in 14 rate by 2001. The Southern Asia subregion suffered 1.3 million under-five deaths in 2021 (about 26 percent of the global total versus 27 percent of live births in 2021). The Southern Asia subregion accounted for 98 percent of the Central and Southern Asia region’s under-five deaths in 2021 (Child Mortality Report, 2022).
Moreover, children living in fragile and conflict-affected situations are especially vulnerable. At 75 deaths per 1,000 live births in 2021, the under-five mortality rate in the 37 countries classified as fragile and conflict-affected situations was three times higher than in all other countries (Child Mortality Report, 2022).
Child survival and the Sustainable Development Goals (SDGs)
The SDG target 3.2 for child mortality aims to end, by 2030, preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births and under-5 mortality to at least as low as 25 deaths per 1,000 live births (WHO, 2023).
Geographic and economic disparities in the risk of death for children threaten the universal achievement of the SDGs (Child Mortality Report, 2022). In more than a quarter of all countries, urgent action is needed to accelerate reductions in child mortality to reach the SDG targets on ending preventable child deaths by 2030. Of the 200 countries analysed, 133 already met the SDG target on under-five mortality, and 13 countries are expected to meet the target by 2030 if current trends continue.
Efforts to accelerate progress need to be scaled up in the remaining 54 countries (nearly three-quarters of which are in the region of Sub-Saharan Africa) to meet the SDG target on under-five mortality by 2030. Of these 54 countries, 37 countries will need to more than double their current rate of progress or reverse a recent increasing trend to achieve the SDG target by 2030 (Child survival and the SDGs, UNICEF, 2023).
Even more countries are at risk of missing the SDG target on neonatal mortality than on under-five mortality. On current trends, 63 countries will need to accelerate progress to meet the neonatal mortality target by 2030, while 55 countries will need to more than double their current rate of decline or reverse a recent increasing trend to meet the target on time (Child survival and the SDGs, UNICEF, 2023).
Achieving the SDG target on under-five mortality on time in countries that are at risk of missing the target would mean averting almost 10 million under-five deaths compared with continuing current trends. If current trends continue, about 40 million children under 5 years of age will die before 2030, half of them newborns. Well over half of these deaths (59 percent) will take place in sub-Saharan Africa (24 million), with another 24 percent occurring in South Asia (9 million) (Child survival and the SDGs, UNICEF, 2023).
Potential solutions for sustainable child survival
To avert the tragic loss of millions of children and adolescents that is projected to occur if the status quo is maintained, the world must expedite efforts to reduce child mortality across the continuum of care, beginning with antenatal care (Child Mortality Report, 2022). According to the World Health Organization, to tackle the most preventable causes of under-5 deaths, it is essential to promote the use of immediate and exclusive breastfeeding as well as to train attendants for antenatal, birth, and postnatal care.
Access to nutrition and micronutrients also play a significant role in children’s life expectancy, as well as the environmental conditions in which the child lives (access to water, sanitation) and the family’s knowledge of danger signs in a child’s health (World Vision, 2016). While the global child death toll is enormous, with appropriate investments, will and policy, it is possible to ensure every child survives (Child Mortality Report, 2022).
Written by Arianna Braga
Internally proofread by Aditi Partha
Last updated on 22 October 2023
References:
Child and youth mortality data ages 5-24, UNICEF, (2023). Child and youth mortality data ages 5-24. Retrieved from UNICEF at https://data.unicef.org/topic/child-survival/child-and-youth-mortality-age-5-24/, accessed on 22 October 2023.
Child Mortality Report (2022). Levels and trends in child mortality. Report 2022. Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation. Retrieved from UNICEF at https://data.unicef.org/resources/levels-and-trends-in-child-mortality/, accessed on 22 October 2023.
Child mortality under 5 years, WHO (2022). Child mortality (under 5 years). Retrieved from WHO at https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-under-5-mortality-in-2020, accessed on 22 October 2023.
Child survival and the SDGs, UNICEF (2023). Child survival and the SDGs. Retrieved from UNICEF at https://data.unicef.org/topic/child-survival/child-survival-sdgs/, accessed on 22 October 2023.
Mortality among children aged 5-14 years, WHO (2019). Mortality among children aged 5-14 years. Retrieved from WHO at https://www.who.int/news-room/fact-sheets/detail/mortality-among-children-aged-5-14-years, accessed on 22 October 2023.
Neonatal mortality, UNICEF (2023). Neonatal mortality. Retrieved from UNICEF at https://data.unicef.org/topic/child-survival/neonatal-mortality/#resources, accessed on 22 October 2023.
Newborn Mortality, WHO (2022). Newborn Mortality. Retrieved from WHO at https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-mortality-report-2021, accessed on 22 October 2023.
Older adolescent, WHO (2022). Older adolescent (15 to 19 years) and young adult (20 to 24 years) mortality. Retrieved from WHO at https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-older-adolescent-(15-to-19-years)-and-young-adult-(20-to-24-years)-mortality, accessed on 22 October 2023.
UNICEF, Under-five mortality (2023). Under-five mortality. Retrieved from UNICEF at https://data.unicef.org/topic/child-survival/under-five-mortality/, accessed on 22 October 2023.
WHO (2023). SDG Target 3.2: End preventable deaths of newborns and children under 5 years of age. Retrieved from WHO at https://www.who.int/data/gho/data/themes/topics/sdg-target-3_2-newborn-and-child-mortality, accessed on 22 October 2023.
World Vision (2016). Child mortality: Top causes, best solutions. Retrieved from World Vision at https://www.worldvision.org/health-news-stories/child-mortality-causes-solutions, accessed on 14 November 2023.
