Millennium Development Goal 4 (MDG 4): Reduce child mortality
TARGET: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
PROGRESS: The global child mortality rate declined by almost one quarter between 1990 and 2006 [PDF] but the international community is not on target to achieve the goal, particularly in sub-Saharan Africa.
Under-five mortality rates in sub-Saharan Africa dropped from 187 per 1,000 live births in 1990 to 160 per 1,000 in 2006. The target for 2015 is 62.
Globally, it dropped from 93 to 72; the target is 31.
SIGNIFICANCE: 136 million babies are born every year [PDF, p.1]. Every drop in the global mortality figures of 1 death per 1,000 live births means some 136,000 fewer child deaths each year. The progress since 1990 (from 93 to 72) means nearly 3 million extra children born in 2001 saw their fifth birthday in 2006.
However, if current trends continue, 4.3 million child deaths will occur in 2015 alone that could have been averted [PDF] had MDG 4 been met
DEFINITION: The UNICEF reports below examine under-5 mortality (and other statistics). They use the term Under-5 Child Mortality (U5CM) to describe the probability of dying between birth and the exact age of five years. Others define child mortality more strictly as age 1-5 (i.e., excluding infant mortality). However, in the discussion below, child mortality should be taken to mean U5CM.
Malnutrition and Child Mortality
Malnutrition is by far the biggest contributor to child mortality, present in half of all cases, says the World Health Organisation (Economist, 24/1/08):
'(I)f the research is right, money for improving nutrition would be the most effective sort of aid around. At the moment, roughly $300m of aid goes to basic nutrition each year, less than $2 for each child below two in the 20 worst affected countries. In contrast, HIV/AIDS, which causes fewer deaths than child malnutrition, received $2.2 billion—$67 per person with HIV in all countries (including rich ones).
'Focusing on nutrition and mortality also makes sense, says April Harding of the Centre for Global Development, a Washington-based think-tank, because it forces policymakers to pay attention to health-care systems as a whole, rather than trying to save children “one disease at a time”. Given the scale of the crisis, the case for aid organisations redirecting money and attention to the problem of hunger looks compelling.'
Maternal and child undernutrition series launched in the Lancet (19/1/08)
UNICEF: The State of the World’s Children 2008
Congo is one of 11 countries where 20% of children die before the age of five, according to a UNICEF report released yesterday (Guardian, 23/1/08). A child born in Sierra Leone has the lowest chance of surviving until the age of five. The report, the State of the World’s Children, says nearly 9.7 million children under five died worldwide last year from disease or lack of food.
The report shows that progress has been made when 2006 is compared with 1990. Connect-World has examined a shorter time period and compared the 2006 data [PDF] with 1997 figures [PDF] (from The State of the World’s Children 1999, p.93) and has uncovered some new results below.
In 1997, 13 countries had an under five mortality rate of 20% or more [Tables 1, 2 below].Ten of those countries have seen improvements since then. Malawi experienced a 44% drop in mortality from 215 to 120 deaths per thousand (mortality was static in the other three countries) [Table 1 below].
Eight of the 10 most populous countries in the world -- accounting for over half of earth’s population -- saw reductions in mortality of between 29% (Pakistan) and 55% (Brazil) [Table 3 below].
Many countries have seen very large improvements. Mortality in Mongolia dropped by over 70% (from 150 to 43 per 1000) [Table 5 below]. In Iraq, it fell by 62% - equivalent to 71,000 fewer deaths in 2006 despite the ongoing conflict.
However, a number of countries have witnessed a considerable deterioration since 1997, notably Botswana and Swaziland, and including Kenya, North Korea and Zimbabwe [Table 4 below].
Taking a longer time period, the global mortality rate has declined by almost a quarter since 1990. Yet, global progress in reducing child mortality is insufficient to reach the fourth millennium development goal (MDG 4).
West and Central Africa are furthest from achieving the goal: the 2008 report says "no progress" has been made. This seems a little unfair when mortality per 1000 live births has fallen there by 22 since 1990. It is a small percentage (11%) compared with many other regions but it is comparable in absolute terms to the drop of 26 in, for example, "on track" East Asia and the Pacific (a region which includes China).
If current trends continue, 4.3 million child deaths will occur in 2015 alone that could have been averted had MDG 4 been met.
Most of the kids who died last year before the age of five could have lived if their parents had unhindered access to proper medical care (OneWorld, 22/1/08).
|
Table 1: Progress in countries where one in five children died before their fifth birthday in 1997* |
|
Under-5 mortality/1000 |
| Country |
1997 |
2006 |
change |
% change |
| Niger |
320 |
253 |
-67 |
-21% |
| Sierra Leone |
316 |
270 |
-46 |
-15% |
| Angola |
292 |
260 |
-32 |
-11% |
| Afghanistan |
257 |
257 |
0 |
0% |
| Mali |
239 |
217 |
-22 |
-9% |
| Liberia |
235 |
235 |
0 |
0% |
| Guinea-Bissau |
220 |
200 |
-20 |
-9% |
| Malawi |
215 |
120 |
-95 |
-44% |
| Somalia |
211 |
145 |
-66 |
-31% |
| Mozambique |
208 |
138 |
-70 |
-34% |
| Congo, Dem. Rep. |
207 |
205 |
-2 |
-1% |
| Zambia |
202 |
182 |
-20 |
-10% |
| Guinea |
201 |
161 |
-40 |
-20% |
| Average |
240 |
203 |
-37 |
-15% |
|
Table 2: Prevalence of high under-five child mortality rates (U5CM)* |
|
No. of countries |
|
U5CM per 1000 live births |
1997 |
2006 |
|
300 or more |
2 |
0 |
|
200 or more |
13 |
11 |
|
100 or more |
49 |
41 |
|
50 or more |
77 |
67 |
|
|
Table 3: Under-five mortality in the world's most populous countries*,† |
|
|
|
|
Under-5 mortality/1000 |
| Rank |
Country |
Pop. (m) |
% of total |
1997 |
2006 |
change |
% change |
|
World |
6,671 |
100.0% |
|
|
|
|
|
1 |
China |
1,323 |
19.8% |
47 |
24 |
-23 |
-49% |
|
2 |
India |
1,128 |
17.0% |
108 |
76 |
-32 |
-30% |
|
3 |
US |
303 |
4.6% |
8 |
8 |
0 |
0% |
|
4 |
Indonesia |
232 |
3.5% |
68 |
34 |
-34 |
-50% |
|
5 |
Brazil |
186 |
2.8% |
44 |
20 |
-24 |
-55% |
|
6 |
Pakistan |
162 |
2.4% |
136 |
97 |
-39 |
-29% |
|
7 |
Bangladesh |
159 |
2.4% |
109 |
69 |
-40 |
-37% |
|
8 |
Nigeria |
148 |
2.2% |
187 |
191 |
4 |
2% |
|
9 |
Russia |
142 |
2.1% |
25 |
16 |
-9 |
-36% |
|
10 |
Japan |
128 |
1.9% |
6 |
4 |
-2 |
-33% |
|
Table 4: Selected countries where under-five mortality rose between 1997 and 2006* |
|
Under-5 mortality/1000 |
| Country |
1997 |
2006 |
change |
% change |
|
Botswana |
49 |
124 |
75 |
153% |
|
Swaziland |
94 |
164 |
70 |
74% |
|
Cameroon |
99 |
149 |
50 |
51% |
|
Solomon Islands |
28 |
73 |
45 |
161% |
|
Azerbaijan |
45 |
88 |
43 |
96% |
|
Burkina Faso |
169 |
204 |
35 |
21% |
|
Equatorial Guinea |
172 |
206 |
34 |
20% |
|
Kenya |
87 |
121 |
34 |
39% |
|
Gambia |
87 |
113 |
26 |
30% |
|
Zimbabwe |
80 |
105 |
25 |
31% |
|
North Korea |
30 |
55 |
25 |
83% |
|
Trinidad & Tobago |
17 |
38 |
21 |
124% |
|
Micronesia |
24 |
41 |
17 |
71% |
Table 5: Selected countries where under-five mortality fell between 1997 and 2006* |
|
Under-5 mortality/1000 |
|
Country |
1997 |
2006 |
change |
% change |
|
Mongolia |
150 |
43 |
-107 |
-71% |
|
Malawi |
215 |
120 |
-95 |
-44% |
|
Cambodia |
167 |
82 |
-85 |
-51% |
|
Iraq |
122 |
46 |
-76 |
-62% |
|
Niger |
320 |
253 |
-67 |
-21% |
|
Somalia |
211 |
145 |
| | 
