The challenge
THE MILLENnIUM CHALLENGE FOR CHILD SURVIVAL
At the same time, the unfinished business of child survival looms large. In 2012, an estimated 6.6 million children died before their fifth birthday, at a rate of around 18,000 per day. Wide disparities in child survival exist between countries: Under-five mortality rates currently range from 2 deaths per 1,000 live births in Luxembourg to 182 in Sierra Leone.
While the global rate of reduction of under-five mortality has more than tripled in 2005–2012 as compared to 1990–1995, it is still well below the required pace to meet the MDG 4 target, and would need to further quadruple between 2012 and 2015 to realize that target. Only two regions — East Asia and Pacific, and Latin America and the Caribbean — are currently on track to meet the 2015 deadline for MDG 4, with CEE/CIS set to reach the threshold a year later (Figure 7). Several regions are on track to meet the MDG 4 criteria by the 2020s, with both Eastern and Southern Africa and the Middle East and North Africa set to reach the goal by 2020, and South Asia by 2021.
Significant disparities in child mortality also persist across regions. In sub-Saharan Africa, one in every 10 children born still dies before their fifth birthday, nearly 16 times the average rate in high-income countries. In 2012, there were 16 countries with an under-five mortality rate of at least 100 deaths per 1,000 live births; all are in sub-Saharan Africa. More rapid progress elsewhere and high fertility rates in the region have seen the global burden of under-five deaths shift towards sub-Saharan Africa; in 1990, this region accounted for 30% of all under-five deaths; by 2012, this figure had reached 50% (Figure 6). South Asia has made faster progress in reducing child deaths and consequently has seen its share of global deaths fall from 37% in 1990 to 32% in 2012.This region has also seen its number of deaths more than halve, from 4.7 million to 2.1 million, over the same period — by far the largest absolute reduction among all regions. Faster progress in other regions has seen the burden of global under-five deaths shift increasingly to sub-Saharan Africa FIG. 6
*In this chart, data for Djibouti and Sudan are not included in the Middle East and North Africa regional total, as they are already included in sub-Saharan Africa. Estimates are rounded, and therefore may not sum to 100%.
Source: IGME 2013.
Number and % of under-five deaths by region, 2012 (thousands and % of global total)
Unless progress on saving lives accelerates across several regions, global achievement of MDG 4 will only occur in 2028 Achievement of MDG 4 by year, globally and by region, if current trends continue in all countries
FIG. 7
Latin America &Caribbean CEE/CIS Middle East &North Africa South Asia
Sub-Saharan Africa Eastern &Southern Africa West & Central Africa
World 2010
2015
2020
2025
2030
2035
Source: UNICEF analysis based on IGME 2013.
REGIONAL DISPARITIES
If current trends in all countries continue, the world as a whole will only reach the target by 2028, 13 years behind schedule, and it will take West and Central Africa four more years to attain the mark. On the same assumption, Eastern and Southern Africa will meet the target one year earlier (2020) than South Asia (2021). At the country level, if current trends persist 22 countries will not meet the MDG 4 target until 2036–2050 — and it is projected that 28 countries will still not have met the target by mid-century. To meet the MDG 4 target by its agreed date of 2015, an additional 3.5 million children’s lives above the current trend rate will need to be saved between 2013 and 2015 — more than two-thirds in sub-Saharan Africa and about one-quarter in South Asia. Particular attention is required for South Asia and sub-Saharan Africa. By 2012, 81% of all under-five deaths were occurring in
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