Health and Healthcare Systems

Child deaths have reached a historic low – but there's still much more to do

UNICEF figures show that the mortality rate of children under the age of five is the lowest it has been since 1990. Image: Unsplash/ Larm Rmah

Amira Ghouaibi
Head, Global Alliance for Women's Health, World Economic Forum
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  • The number of deaths of children under five has reached its lowest recorded rate, according to UN figures.
  • But progress is slowing and the world is still off target to reach the Sustainable Development Goals (SDGs).
  • High-impact interventions are making a difference in some lower-income countries, but long-standing inequities mean global survival rates vary significantly.

The number of children dying under the age of five has reached the lowest rate ever recorded.

Millions fewer children are dying before their fifth birthday than was the case just a few decades ago. In the period between 2000 and 2022, the under-five mortality rate has more than halved. And in several low- and lower-middle-income countries, survival rates are outpacing this trend.

The number of deaths of under-fives fell to 4.9 million in 2022, or 1 in 27 children born, according to UNICEF figures. This compares to 1 in 11 in 1990. But while this is undoubtedly progress, it still equates to roughly 13,400 young deaths every day in 2022, and demonstrates the ongoing health threats faced by people around the world, particularly marginalized children.

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Global mortality rates and number of deaths by age, 1990–2022
Deaths among under-fives have more than halved since 2000. Image: UNICEF

Death rates remain high

Nearly half of deaths in under-fives in 2022 were among the very youngest children – those under a month old. There were also millions of stillbirths – deaths that UNICEF says are often missed by policymakers both in data collection and in programmes rolled out.

In addition to these deaths, 2.1 million children and adolescents between the ages of 5 and 24 died in 2022.

How many children younger than 5 has the world lost since 1990?
Since 1990, 278 million children have died before the age of five. Image: UNICEF

Unequal chances of survival

Although child mortality rates are declining as a whole, there remain huge and entrenched inequities that affect survival rates. Children born in the poorest households or those in a fragile or conflict-affected area have a far smaller chance of surviving beyond five years old. A child born in sub-Saharan Africa is 18 times more likely to die before turning five than one born in Australia or New Zealand, for example.

Infectious diseases, including pneumonia, diarrhoea and malaria, remain among the leading causes of death in young children, along with preterm birth and complications in childbirth. Many of these diseases are preventable and treatable.

What are the leading causes of death among newborns and children younger than 5?
Many causes of child death are preventable or treatable. Image: UNICEF

Stalling progress

UNICEF credits progress in bringing down child deaths to a sustained commitment from governments, organizations, local communities, healthcare professionals and families. But progress in recent years has stalled.

Between 2015 and 2022, under the United Nations’ Sustainable Development Goals, childhood mortality was reduced by 2.1%. Between 2000 and 2015, during the period of the Millennium Development Goals, under-five mortality fell 3.8%.

Unless urgent action is taken, UNICEF says, many low- and lower-middle-income countries will not meet the SDG targets on baby and child mortality. And an additional 35 million children under the age of five will die by 2030.

Since 2000, how much progress has been made to save under-five lives?
Less progress has been made on the neonatal mortality rate compared to children 1-59 months old. Image: UNICEF

That is not to say that progress isn’t possible – several low- and lower-middle-income countries have managed to significantly cut child mortality by investing in maternal, newborn and child health.

There are also some high-impact interventions that can be prioritized – having skilled people present at births, antenatal and postnatal care, improved diagnosis and treatment of childhood illness, and vaccinations, for example.

Efforts to reduce malnutrition also have a significant impact, alongside clean water and sanitation.

But patchy healthcare provision can prevent these interventions from reaching everyone. In addition, the pandemic disrupted many health programmes, including routine childhood vaccines for example, and its effects are still being felt in healthcare systems across the world.


What is the World Economic Forum doing to improve healthcare systems?

The World Economic Forum’s Global Health and Healthcare Strategic Outlook lays out a strategy to build a modern fit-for-purpose healthcare system, drawing lessons from the pandemic.

UNICEF also highlights the importance of data in understanding child mortality, helping us identify trends and root causes of death. Unfortunately, data collection can often fall short, particularly in areas where children are most vulnerable, and in fragile regions or those in conflict.

Ultimately, the knowledge needed to bring childhood deaths drastically down already exists. And we know what interventions are most effective. The solution is in ensuring that they reach every child, no matter where they are born.

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