UNDER EMBARGO UNTIL 00:01 GMT, 13 September 2013
Child Survival Facts and Figures
(Including ‘A Promise Renewed’ Progress Report 2013 figures)
1. ABOUT CHILD MORTALITY ESTIMATES1
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Almost half as many children under-five died in 2012 (6.6 million), compared to 1990 (12.6 million).
Globally, the annual reduction in child mortality has been accelerating – from 1.2 per cent (1990-1995), to 2.3 per cent (1995-2000), to 3.7 per cent (20002005), to 3.9 per cent (2005-2012).
About 17,000 fewer children die each day than two decades ago. Still, 18,000 children under five die every day, mostly from preventable causes.
The global toll of under-five deaths over the past two decades is staggering: 216 million children died before the age of 5 between 1990 and 2012 – more
than the total population of Brazil, the fifth most populous country in the world.
The direct impact of efforts to end preventable child deaths is that 90 million children’s lives were saved — lives that would have been lost had mortality
rates remained at 1990 levels. That is roughly the equivalent of the current population of Germany.
Most of those saved were children in South Asia (38 per cent) and sub-Saharan Africa (30 per cent). However, sub-Saharan Africa and South Asia together
still account for 4 out of 5 under-five deaths globally.
Of the 61 high-mortality countries with at least 40 deaths per 1,000 live births in 2012, 25 managed to at least halve their under-five mortality rates between
1990 and 2012 — with seven (Bangladesh, Ethiopia, Liberia, Malawi, Nepal, United Republic of Tanzania and Timor-Leste) having already reduced the
under-five mortality rate by two-thirds or more.
REGION-SPECIFIC DATA:2
 South Asia has made strong progress on reducing preventable child deaths, more than halving its number of deaths among children under-five since 1990.
But nearly 1 in every 3 under-five deaths still takes place in this region, and it has not seen a major acceleration in the rate of reduction. Three regions (East
Asia and Pacific, Latin America and the Caribbean, and Central and Eastern Europe and the Commonwealth of Independent States) have reduced their
under-five mortality rates by 60 per cent or more.
 Sub-Saharan Africa and Middle East and North Africa are the only regions that have experienced a consistent acceleration in the pace of reducing underfive deaths since 1990. Since 2005, sub-Saharan Africa has been reducing its rate of child mortality more than five times faster than during 1990-1995.
 Sub-Saharan Africa has registered a 45 per cent decline in the under-five mortality rate from 1990 to 2012. The region faces a unique and urgent challenge
1
2
‘A Promise Renewed’ (APR) Progress Report 2013
Ibid
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in accelerating progress. By mid-century it will be the region with the single biggest population of under-fives, accounting for 37 per cent of the global total
and close to 40 per cent of all live births. And it is the region with least progress on under-five mortality to date.
Within sub-Saharan Africa, there is beginning to be a divergence in child survival trends between Eastern and Southern Africa, and West and Central Africa.
Eastern and Southern Africa has managed to reduce its under-five mortality rate by 53 per cent since 1990 and in the past seven years has been among the
best performing regions in the world, reducing under-five mortality at an annual rate of 5.3 per cent in 2005-2012. But it still has high rates of mortality, with
one in every 13 children dying before the age of five.
In contrast, West and Central Africa has seen a drop of just 39 per cent in its under-five mortality rate since 1990, the least progress among all regions.
Moreover, its annual rate of reduction, while accelerating, is still the slowest in the world. The region also has the highest rate of mortality, with almost one in
every eight children dying before the age of five.
Upper-middle-income countries have enjoyed the most success in reducing under-five mortality rates between 1990 and 2012, registering a 63 per cent
decrease over the period.
High-income countries have the lowest rates of under-five mortality on average, at 6 per 1,000 live births in 2012. Finland, Iceland, Japan, Luxembourg,
Norway, Singapore and Sweden, all of which are high-income countries, have the lowest rates of under-five mortality.3
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 goal a year later. Several regions are on track to meet the MDG 4 criteria by the 2020s, with Eastern and Southern Africa and the Middle
East and North Africa set to reach the goal by 2020 and South Asia by 2021.4
2. ABOUT CAUSES OF DEATHS
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3
Globally, the leading causes of deaths among children under five include pneumonia (17 per cent): preterm birth complications (15 per cent); Intrapartumrelated complications (10 per cent), diarrhoea (9 per cent); and malaria (7 per cent). 5
Pneumonia is the leading killer of children under five, causing 17 per cent of all under-five deaths worldwide – a loss of roughly 1.1 million lives in 2012. The
bulk of these deaths occur in just two regions, sub-Saharan Africa and South Asia. The impact is worst among the poorest and most marginalized children.6
From 2000 to 2012, total annual deaths from diarrhoea among under-five children decreased by more than 50 per cent, from almost 1.3 million in 2000 to
about 0.6 million in 2012.Effective, proven interventions for tackling diarrhoea do exist – for example, oral rehydration salts (ORS), zinc and rotavirus
vaccine. But children are still dying because these interventions are often not available or accessible where they are needed most.7
Increased global investment and scale-up of malaria control interventions since 2000 have saved over 1 million lives. Nevertheless, malaria remains a major
killer of children, particularly in sub-Saharan Africa, where it accounts for 14 per cent of child deaths.8
Globally, nearly half of child deaths are attributable to undernutrition.9
APR 2013
Ibid
5
Ibid
6
Ibid
7
Ibid
8
Ibid
9
Ibid
4
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Without antiretroviral treatment, half of all HIV-infected children die before the age of two.10 In countries with high HIV prevalence in sub-Saharan Africa,
HIV-associated mortality in 2010 among children under five ranged from 10 per cent to 28 per cent of total under-five mortality in some countries with high
HIV prevalence in sub-Saharan Africa.11
3. NEWBORN MORTALITY
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The first 28 days of life represent the most vulnerable time for a child’s survival.12
Around 44 per cent of deaths among children under five occur during the neonatal period (i.e. during the first 28 days of life). In 2012, this amounted to 2.9
million deaths worldwide.13
The current annual rate of decline for newborn mortality is significantly lower than for older children under five.14
The heaviest burdens are in South Asia and sub-Saharan Africa, which have both the highest neonatal mortality rates among regions and the largest
number of annual births.15
Newborn mortality is an increasing challenge for high-mortality countries. In Bangladesh, newborn deaths account for 60 per cent of the total under-five
mortality (57 per cent in Nepal, 55 per cent in India).16
Four out of five newborn deaths result from three preventable and treatable conditions: complications due to prematurity, complications during childbirth,
and infections.17
Solutions include investment in maternal care, specifically labour and delivery care18 and other high-impact interventions including care during the 24 hours
around the time of birth, early and exclusive breastfeeding, keeping the baby warm, good hygiene, antibiotics to treat infection, and neonatal resuscitation.19
Newborn deaths can be reduced by more than two-thirds if these interventions are made more widely available.20
4. MAKING THE INVESTMENT CASE21
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10
A study found that reducing child deaths by 4.25 per 1000 children born to mothers with low levels of education, can result in an almost 8 per cent increase
in GDP per capita 10 years later.
Reducing health inequality by 1 per cent per year could increase a country’s annual rate of GDP growth by 0.15 per cent. This makes reducing health
inequity by targeting the poorest children a very strong policy alternative for improving economic growth.
APR 2013
http://www.un.org/ru/publications/pdfs/renewed_%20progress%20report%202012.pdf
APR 2013
13
Ibid
14
Every Newborn website, http://www.globalnewbornaction.org/Documents/Every-Newborn-toolkit-key-messages.pdf
15
APR 2013
16
APR 2013
17
Every Newborn website, op. cit
18
APR 2013
19
Every Newborn website, op. cit
20
Ibid
21
UNICEF policy paper ‘Investing in children’, http://www.unicef.org/socialpolicy/files/Investing_in_Children_19June2012_e-version_FINAL.pdf
11
12
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The Copenhagen Consensus 2012 identified treating undernutrition, the underlying cause for nearly half of under-five child mortality, as the key global
priority for policymakers and philanthropists. For about $100 per child, a bundle of interventions could reduce chronic undernutrition by 36 per cent in
developing countries. Even in very poor countries, it was found that each dollar spent has at least a $30 payoff.
Social protection can help lower infant mortality. In Mexico, infant mortality decreased by 8 per cent on average and by 17 per cent in rural areas.
5. SECTOR-SPECIFIC FACTS AND FIGURES
Nutrition:
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Proper nutrition in the first 1,000 days of a child’s life is critical to prevent undernutrition and stunting, leading to better health and learning ability, and
expanding opportunities for development and productivity in the future.22
Nutrition-related programmes that will help prevent stunting and reduce child mortality include programmes for management of acute malnutrition, support
and promotion of breastfeeding and complementary feeding, and provision of appropriate micronutrient interventions for mother and child.23
About 800,000 child deaths are linked to poor breastfeeding practices every year. 24 Children who are exclusively breastfed for the first six months of life are
14 times more likely to survive than non-breastfed children.25
Health:
 More than 2 million children’s lives can be saved by 2015 in countries where child mortality rates are highest by increasing access to proven, cost-effective
interventions for pneumonia and diarrhoea, raising the coverage to levels already enjoyed by the richest 20 per cent of the population in those same
countries.26
 Pneumonia is still the leading killer of children. One reason for this is lack of awareness. Globally, only 60 per cent of children with a cough and difficulty
breathing [symptoms of suspected pneumonia] are brought to a health care provider for treatment. Another risk factor is that not enough children are
exclusively breastfed for the first six months of their lives. Globally, only 39 per cent of infants are exclusively breastfed for up to six months.27
 Diarrhoea remains one of the largest killer of children under five, although deaths from this cause dropped by more than 50 per cent during the last decade.
ORS and supplemental zinc, combined with continued feeding, are the recommended interventions for treating diarrhoea. Rotavirus vaccine is another
important intervention. Three-quarters of all under-five child deaths28 from diarrhoea occur in just 15 countries. ORS treatment coverage in these countries
remains very low, in 2012 reaching less than 30 per cent of children with diarrhoea. Children in the richest 20 per cent of households may be up to four
times more likely to receive ORS when they are sick with diarrhoea than children in the poorest 20 per cent of households.29
‘Improving Child Nutrition: The Achievable Imperative for Global Progress’ Report 2013, UNICEF key messages
APR 2013
24
The Lancet, ‘Maternal and child undernutrition and overweight in low-income and middle-income countries’ May 2013, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60937-X/fulltext
25
APR 2012
26
APR 2012 UNICEF key messages
27
APR 2013
28
APR 2013
29
Ibid
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23
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Efforts to combat infectious diseases resulted in major declines in under-five child deaths. Measles cases recorded have declined by three quarters thanks
in large part to enhanced vaccination programmes.30
Immunization is among the most successful and most cost-effective health interventions, saving an estimated 2-3 million lives globally every year.
Immunization activities contributed to reduction of measles-related mortality, contributing to an estimated 18 per cent of the total reduction in under-five
deaths between 2000- 2010.31 Vaccination has always been at the heart of UNICEF’s mission. In 2012, UNICEF supplied vaccines worth over one billion
US dollars 32. New vaccines have contributed to a drastic reduction in pneumonia and diarrhoea deaths worldwide – two leading killers for children underfive.33
Giving good care to women during pregnancy and at the time of childbirth is crucial not only for saving mothers’ lives but their babies, too. Infants who lose
their mothers in the first 6 weeks of life face a greater chance of dying before age 2 than do infants whose mothers are survive.34
Most maternal deaths are preventable through adequate nutrition, proper health care, the presence of a skilled birth attendant during delivery35 and access
to family planning. In sub-Saharan Africa, less than half of all births were attended by a skilled birth attendant in 2011.36
Water and Sanitation:
 Lack of safe water and the practice of open defecation and poor hygiene habits are significant threats to the survival and health of children.37
 About 2.5 billion people – 36 per cent of the world’s population – lack hygienic and safe sanitation facilities and more than 768 million people still drink water
from unimproved sources.38 Thousands of children get sick and are killed every day from illnesses such as diarrhoea.39
 Open defecation is still practiced by just over 1 billion people worldwide, mostly in rural areas of poor countries, putting entire communities at risk of
diarrhoeal and other diseases.40
 Regular handwashing with soap could reduce the risk of lower respiratory infections such as pneumonia by 23 per cent, and could reduce diarrhoea by 42
per cent.41
 Thousands of girls are kept from school because they are forced to spend hours every day fetching water for their families. When schools lack separate
toilet facilities for girls, this also often forces them to drop out –especially when they reach puberty.42
Protection:43
30
APR 2012
APR 2013
32
http://www.unicef.org/supply/index_immunization.html
33
APR 2012 UNICEF key messages
34
APR 2013
35
Ibid
36
APR African Leadership for Child Survival, UNICEF key messages
37
APR 2013
38
Joint Monitoring Report 2013, http://www.wssinfo.org/fileadmin/user_upload/resources/JMPreport2013.pdf
39
Childinfo, http://www.childinfo.org/sanitation.html
40
APR 2013
41
Ibid
42
APR 2012, UNICEF key messages on sector inter-linkages
43
Ibid
31
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Registration at birth: When children are not registered at birth, they are not counted and simply do not exist. This leaves them at risk of being exploited and
makes them less likely to receive essential services such as health care and schooling. Globally (excluding China), approximately half of all children under 5
are not registered.
Child marriage: Evidence shows that when girls marry as children they often have to abandon formal education and frequently become pregnant at a young
age.
If a mother is under 18, the risk of her infant dying in its first year of life is 60 per cent greater than an infant born to a mother older than 19. Even if the child
survives, he or she is more likely to suffer from low birth weight, undernutrition and diminished physical and cognitive development.
Violence against children: Victims of violence are more likely to engage in violent behaviour themselves, creating a vicious cycle. Children who have
experienced violence may have impaired cognitive development and will likely be less productive citizens.
Gender equality and girls’ education:
 The risk of maternal death is 2.7 times higher among women with no education, and two times higher among women with 1-6 years of education than
among women having more than 12 years of education.44
 A child born to a mother who can read is 50 per cent more likely to survive past the age of five. Children of mothers with a secondary education or higher
are twice as likely to survive beyond the age of five as children of mothers who have no education.45
 Educated girls are less likely to marry early, more likely to have a job with a higher income, and are better equipped to protect their children from exploitation
and disease.46
 An educated woman who has the decision-making power to choose what is best for herself and her family is more likely to keep her home healthy and is
more likely to ensure better education and healthcare for her children.47
 Each extra year of a mother’s schooling reduces the probability of an infant dying by 5 to 10 per cent.48
COUNTRY SPECIFIC DATA (Philippines)
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44
69,000 children in the Philippines die every year before they reach their 5th birthday. Of this number 47 per cent are during the neonatal period
(one month after birth). This is about 32,000 newborns dying every year.
Under-five mortality rate declined by 49 per cent over 20 years. Please see attached file (powerpoint attached in the email).
The rates of decline in under five mortality have slowed down. This is probably due to the very slow (almost stagnant) rates of decline of
newborn mortality. Newborn deaths account for more and more child deaths, and presently the biggest chunk (47%) of all under-five deaths.
From 2011 Family Health Survey:
 Under-five Mortality highest in MIMAROPA, Eastern Visayas, Northern Mindanao, CARAGA, Bicol Region. A child born in these regions is
2-2.5 times less likely to reach his/her fifth birthday than one born in NCR.
APR 2013,
APR 2012, UNICEF key messages on sector inter-linkages
46
Ibid
47
Ibid
48
APR 2012, UNICEF Key messages
45
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Neonatal Mortality highest in Eastern Visayas, MIMAROPA, Northern Mindanao, Davao, Bicol Regions. A baby born in these regions is 23.5 times less likely to survive his/her first month than one born in NCR.
The top three causes of child deaths in the Philippines are 1. complications and infections during the neonatal period (one month after birth)
2.Pneumonia 3.Diarrhea
Almost one third of neonatal deaths are due to babies being born preterm (before the 37th week of pregnancy)
14 per cent of deaths among Filipina women of reproductive age are due to pregnancy.
Every day, 13 mothers die from pregnancy-related complications. A newborn whose mother has died during childbirth is 3 to 10 times more
likely to die within his/her first two years of life.
More than half (55%) of births in the Philippines are delivered at home by unskilled birth attendants. This leads to the three delays that cause the
deaths of mothers and newborns: 1. delay in seeking care 2. delay in reaching appropriate care 3. delay in receiving appropriate care in a health
facility
PHILIPPINES
U5
mortality
rank
U5 mortality rate (deaths per 1,000 live births)
Number of U5
deaths
(thousands)
Infant mortality
rate (deaths per
1,000 live
births)
Number of
infant deaths
(thousands)
2012
1990
2000
1990
1990
75
59
40
2012
30
Decline %
(1990-2012)
Annual rate of
reduction %
(1990-2012)
1990
2012
49
3.1
119
69
41
For further information, please contact:
Marge Francia, Media Officer, mfrancia@unicef.org, Tel +632 9010173,Mob. +63 9178589447
2012
24
85
2012
54
Neonatal
mortality rate
(deaths per
1,000 live
births)
1990
2012
Number of
neonatal
deaths
(thousands)
23
47
14
1990
2012
32