As leaders we have a duty therefore to all the world’s people, especially the most vulnerable and, in particular, the children of the world, to whom the future belongs. —United Nations Millennium Declaration (2000)
For the first time since 2006, the number of children who died before their fifth birthday fell below 10 million. In developing countries child mortality declined about 25 percent, from 101 per 1,000 in 1990 to 73 in 2008. The fourth Millennium Development Goal (MDG) aims at reducing by two-thirds, between 1990 and 2015, the under-five mortality rates.
While progress has been made, many countries in Sub-Saharan Africa have made little progress—there, one child in seven dies before the fifth birthday. The odds are slightly better in South Asia, where one child in thirteen dies before the fifth birthday. These two regions remain overriding priorities for child survival interventions such as immunizations, exclusive breastfeeding, and insecticide-treated nets.
Thirty-nine countries have achieved or are now on track to achieve the target of a two-thirds reduction in under-five mortality rates. Two of the poorest countries in Sub-Saharan Africa, Eritrea and Malawi, have made remarkable progress. Successful countries now account for half the population of low- and middle-income economies.
Preventing child deaths
Immunizations for measles have continued to expand worldwide and in all regions, coverage is now more than 70 percent, resulting in marked improvements in child survival. However, severe disparities remain within countries. Only 40 percent of poor children are immunized, compared with more than 60 percent of children from wealthier households. In some countries, however, the poor have shared in these health improvements. In Mozambique immunization coverage increased from 58 percent in 1996 to 77 percent in 2002. The poorest 40 percent of households were the beneficiaries of most of this increase. Despite all these improvements, measles remains one of the leading causes of vaccine-preventable child mortality.
Life expectancy begins at birth
Infant mortality is the primary contributor to child mortality. Improvements in infant and child mortality are the major contributors to increasing life expectancy in developing countries. Success in reducing infant mortality may be viewed as a general indicator of progress toward the human development outcomes in the Millennium Development Goals: access to medicines, health facilities, water, and sanitation; fertility patterns; maternal health; maternal and infant nutrition; maternal and infant disease exposure; and female literacy.