Every September, the UN announces the number of children under five who died the previous year in its Child Mortality Report. And the numbers are plummeting.

In 1990, 12 million children under five died. In 2010 it was 7.6 million. In 2015 it was 5.9 million. If numbers had continued at the 1990 rate, 122 million more children would have died.

In fact, child mortality rates have more than halved since 1990.

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However, 16,000 children are still dying every day through preventable illnesses.

Chance of survival is geographic

A child’s chance of survival is still vastly dependent on where they are born.

One in 12 children born in sub-Saharan Africa will die before their fifth birthday. That’s more than 12 times higher than the 1 in 147 average in high-income countries. Southern Asia has the second-highest under-five mortality rate in the world – about 1 child in 19 dies before age five.

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Simple steps

The most dangerous time for a child is on or around birth. A massive 45% of under-five deaths occur in the neonatal period – the first 28 days of life.

Prematurity, pneumonia, complications during labour and delivery, diarrhoea, sepsis and malaria are leading causes of deaths in children under 5 years old.

But most child deaths are easily preventable. Quality care around the time of childbirth, including simple affordable steps like ensuring early skin-to-skin contact, exclusive breastfeeding and extra care for small and sick babies, can save thousands of lives every year.

What’s working?

The Bill and Melinda Gates Foundation has been following childhood mortality numbers for more than two decades. In their latest annual letter to their biggest single contributor, Warren Buffet, they explain how initiatives in Rwanda have contributed to the reduction in child mortality.

From 2008 to 2015 Rwanda cut its newborn mortality rate by 30%, and it was the result of simple steps. Encouraging breastfeeding in the first hour and exclusively for the first six months, cutting the umbilical cord in a hygienic way, and skin-to-skin contact between mother and baby to raise the baby’s body temperature immediately after birth all led to big drops in newborn deaths.

In addition, Rwanda doubled the percentage of childbirths attended by a skilled worker.

By comparison, Mali, which has a comparable GDP, has a newborn mortality rate of 38 deaths per 1,000 – double that of Rwanda.

Vaccination is also key

This interactive map shows how, in most regions, Diphtheria-tetanus-pertussis (DTP3) vaccine coverage has consistently increased since 2000. Global coverage was at 86% in 2015.

In addition, research shows that every $1 spent on childhood immunizations in Africa returns $44 in economic benefits

“We have to acknowledge tremendous global progress, especially since 2000 when many countries have tripled the rate of reduction of under-five mortality,” said the Deputy Executive Director of the UN Children’s Fund (UNICEF), Geeta Rao Gupta, on the Child Mortality Report.

“But the far too large number of children still dying from preventable causes before their fifth birthday – and indeed within their first month of life – should impel us to redouble our efforts to do what we know needs to be done. We cannot continue to fail them.”