Child Survival Shows Progress, but Burden Still Heavy for Poorest Countries

(November 2012) Each day, around 19,000 children die before reaching age 5. That number is 14,000 fewer per day than two decades ago, reflecting global progress in child survival. UNICEF’s recent report, Committing to Child Survival: A Promise Renewed, shows that the number of children who die before age 5 has dropped from nearly 12 million in 1990 to just under 7 million in 2011.1

According to the report, since the Millennium Development Goals were set in 1990 “the rate of decline in under-5 mortality has drastically accelerated, from 1.8 percent per year during the 1990s to 3.2 percent between 2010 and 2011.” All world regions have experienced sharp falls in mortality rates. In 2011, four world regions reported more than halving their rates of under-5 mortality: Latin America and the Caribbean (19 deaths per 1,000 live births); East Asia and the Pacific (20 deaths per 1,000); Central and Eastern Europe and the Commonwealth of Independent States (21 per 1,000); and the Middle East and North Africa (36 per 1,000).

The goal is to end preventable child deaths. In June 2012, the Child Survival Call to Action was convened by the governments of Ethiopia, India, and the United States, together with UNICEF, and 700 partners from public, private, and global sectors. A demonstration at the meeting showed that all countries can lower child mortality rates to 20 per 1,000 live births by 2035, which they believe, with doubling of efforts, can be accomplished.

South Asia and Sub-Saharan Africa Bear Burden of Most Deaths

Still, the economically poorest and least developed countries continue to bear the heaviest burden of child deaths: More than four-fifths of all under-5 deaths in 2011 occurred in South Asia and sub-Saharan Africa—regions that will account for much of the world’s births and young population in the coming years.

The growing gap between these two regions and the rest of the world underscores the inequities that remain in child survival. One in 9 children dies before their fifth birthday in sub-Saharan Africa, the highest regional rate of under-5 mortality, and where almost half of all child deaths under age 5 occur globally. And despite rapid gains in reducing the rate in South Asia, that region’s share of global under-5 deaths remains second highest, at one-third of all deaths.

Even more disparities emerge at the subnational level. About half of all under-5 deaths occurred in just five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China (see table). Eight of the 10 countries listed below are in fragile or conflict-affected states, according to UNICEF, exacerbating existing precarious health conditions. Children born to impoverished households, in rural areas, and to mothers without basic education are vulnerable to more health problems.

Number of Under-5 Deaths by Country, 2011

Country Deaths % of Global Total
Afghanistan 128,000 2
Bangladesh 134,000 2
China 249,000 4
Congo, Dem. Rep. 465,000 7
Ethiopia 194,000 3
India 1,700,000 24
Indonesia 134,000 2
Nigeria 756,000 11
Pakistan 352,000 5
Uganda 131,000 2
Other 2,700,000 39

Source: UNICEF, Committing to Child Survival: A Promise Renewed, Progress Report 2012 (New York: UNICEF, 2012): figure 8.

The neonatal period—the first 28 days of life—is when most deaths in children under 5 occurred. The bulk of neonatal deaths result from preterm birth complications and complications during delivery, of particular concern because mothers in the world’s poorest countries are often giving birth at home rather than in a health facility with the necessary resources. Four in 10 children do not survive their first month of life.

Children under 5 can also be fatally susceptible to infectious diseases, leading to nearly two-thirds of deaths. Pneumonia, diarrhea, malaria, meningitis, tetanus, HIV, and measles are common childhood illnesses, and these deaths can be easily prevented by prioritizing the poorest children, noted the UNICEF report. Many of these deaths from infectious diseases occur in children who are already weakened by undernutrition.

Strategies to Accelerate Progress

According to UNICEF, half of the world’s countries are already at or below the 2035 goal set at the June meeting, and only need to sustain these gains and target efforts at subnational populations. But the other half of the world needs much more action and commitment. A Promise Renewed lists five strategies to lower mortality rates, focusing on those countries with the highest rates and burdens:

  1. Concentrate resources on countries and regions with the most child deaths: sub-Saharan Africa, South Asia, fragile states, and the least developed countries.
  2. Increase efforts among high-burden populations, such as those in India and Nigeria.
  3. Focus on expanding and investing in vital health services.
  4. Address underlying causes. Invest in education, infrastructure, water and sanitation, and jobs.
  5. Take shared responsibility for the goal of drastically reducing the deaths of children under age 5 in the next two decades.

Tyjen Tsai is a writer/editor at the Population Reference Bureau.


  1. UNICEF, Committing to Child Survival: A Promise Renewed, Progress Report 2012 (New York: UNICEF, 2012).