Despite remarkable progress, 15,000 children and 800 women still die every day mostly of preventable or treatable causes

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This blog is based on new child and maternal mortality estimates released jointly today by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) and United Nations Maternal Mortality Estimation Inter-Agency Group (UN MMEIG).

The world made remarkable progress in child survival between 1990 and 2018. The under-5 mortality rate—the probability of a child dying between birth and his or her 5th birthday—fell by over 50% to 39 deaths per 1,000 live births. Mortality among children of ages 5-14 years also fell by over 50% to 7 deaths per 1,000 children. The reduction in the under-5 mortality rate has accelerated and nearly doubled since 2000. It now declines by 3.8% annually, compared to 2% between 1990 and 2000.

Despite progress, there are still huge disparities in child survival by region. In 2018, around 8 in 10 under-5 deaths occurred in just two regions: Sub-Saharan Africa (54%) and South Asia (28%). Sub-Saharan Africa continues to suffer the highest under-5 mortality rate in the world, followed by South Asia. One in 13 children in Sub-Saharan Africa and 1 in 24 children in South Asia die before their 5th birthday.

According to the UN IGME report, in 2018, 121 countries had already achieved an under-5 mortality rate below the Sustainable Development Goal (SDG) target of 25 or fewer deaths per 1,000 live births. Of the remaining 74 countries, 20 are on track to achieving SDGs if current trends continue. Progress must accelerate in 54 countries to reach the SDG target by 2030.

Somalia, Nigeria, Chad, Central African Republic, Sierra Leone and Guinea are among the countries with the highest under-5 mortality with more than 100 deaths per 1,000 live births. This rate is 20 times more than the rate of under-5 deaths in high income countries (5 deaths per 1,000 live births).

The neonatal period (the first month of life) is a critical period for child survival. Between birth and the 15th birthday, the risk of dying is highest in the neonatal period. About 40% of deaths under 15 years of age occur in the first month of life. Globally, an estimated 2.5 million newborns died in the first month of life in 2018, which is approximately 7,000 newborns every day. Progress in reducing neonatal mortality is slower than progress for older ages. As a result, the share of neonatal deaths relative to all under-5 deaths has increased.

Around the time of a child’s birth is also critical for mothers.

The global maternal mortality ratio (MMR) declined 38%, from 342 deaths per 100,000 live births in 2000, to 211 in 2017. That said, an estimated 295,000 women died due to complications during pregnancy and childbirth in 2017.

In 2017, Sub-Saharan Africa had the highest MMR among seven regions, at 534 deaths per 100,000 live births. South Asia was second-highest with 163 deaths per 100,000 live births.  South Asia saw the greatest decline between 2000 and 2017. Its MMR fell 59%, from 395 to 163 deaths per 100,000 live births.

As with child deaths, over 80% of the global burden of maternal deaths are in Sub-Saharan Africa (68%) and South Asia (19%). East Asia and Pacific account for 7% of global maternal deaths, and the rest of the world share the remaining 5%.

Globally, the lifetime risk of maternal death nearly halved between 2000 and 2017—from 1 death in 100 women to 1 in 190. The risk is highest in Sub-Saharan Africa because of the incidence of high risk per birth and high fertility; 1 out of 38 women still died in 2017 due to pregnancy or childbirth.

Countries with highest and lowest lifetime risk of maternal death, 2017

 Country

 Lifetime risk of maternal   death (1 death in)

 Chad

                           15

 South Sudan

                           18

 Sierra Leone

                           20

 Somalia

                           20

 Nigeria

                           21

 

 

 Belarus

                     23,800

 Norway

                     25,700

 Greece

                     26,900

 Poland

                     30,300

 Italy

                     51,300

 

In 2017, the most dangerous countries in the world to give birth were Chad (1 in 15) and South Sudan (1 in 18) although this has slightly improved from 1 death in 10 women in 2000. In high income countries, the risk is much lower. For example, the risk is 1 death in 51,300 women in Italy.

Given the pace of progress between 2000 and 2017, the global MMR is not likely to achieve the SDG target of below 70 deaths per 100,000 live births by 2030. Faster progress is needed.

Reports call for higher coverage of quality care for mother and baby

Both the UN IGME report and the UN MMEIG report urge action to accelerate progress in preventing maternal and child deaths, as too many women and children continue to die from easily preventable and treatable causes. Given that almost half of under-5 deaths occur shortly after birth, many child deaths and maternal deaths can be prevented by reaching high coverage of quality antenatal care, skilled care at birth, and postnatal care for mother and baby.

 

These mortality estimates were produced by the UN IGME and UN MMEIG. The UN IGME includes UNICEF, the World Health Organization, the World Bank Group, the United Nations Population Division, and the UN MMEIG includes the same four agencies and UNFPA. The groups were formed to share data on mortality, harmonize estimates within the UN system, improve methods for child and maternal mortality estimation, and to report on progress towards the SDGs. The groups continue to produce reliable and transparent mortality estimates to track countries’ progress towards SDG targets 3.1 and 3.2. All data, estimates, and details on methods are available on the Child Mortality Estimates (CME INFO) website and WHO website. The new estimates are also available in the World Bank’s World Development Indicators and HealthStats databases.


Glossary:

Under-five mortality rate: Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.

Infant mortality rate: Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.

Neonatal mortality rate: Probability of dying in the first 28 days of life, expressed per 1,000 live births.

Probability of dying among children aged 5-14 years: Probability of dying among children aged 5-14 years, expressed per 1,000 children aged 5.

Maternal mortality ratio: Number of maternal deaths during a given time period per 100,000 live births during the same time period.

Maternal deaths: Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from unintentional or incidental causes.

Lifetime risk of maternal deaths: Probability that a 15-year-old woman will eventually die from a maternal cause.

Authors

Emi Suzuki

Demographer, Development Data Group, World Bank

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