Thirty years ago, the world made a commitment to protect and fulfil children’s rights as enshrined in the Convention on the Rights of the Child. Among the most fundamental of these rights is the right of every child to survive. While substantial progress in child survival has been made since then, the failure to fully meet that commitment reverberates today for millions of children: In 2018 alone, 5.3 million children died before reaching their fifth birthday and almost 1 million children aged 5–14 years died.
It is especially unacceptable that these children and young adolescents died largely of preventable or treatable causes like infectious diseases and injuries when we have the means to prevent these deaths. The continued burden of child deaths is a call to redouble efforts to realize the Convention’s promise and other international human rights commitments that protect every child’s right to survive.
Although the global number of child deaths remains high, the world has made tremendous strides in reducing child and young adolescent mortality over the past few decades. The global under-five mortality rate declined by 59 per cent from 93 deaths per 1,000 live births in 1990 to 39 in 2018, while mortality among children aged 5–14 years fell by 53 per cent from 15 to 7 deaths per 1,000 children aged 5. Still, the burden of child deaths remains immense – the number of children aged 0–14 years that died in 2018, 6.2 million, is equivalent to the current population of Nicaragua.
The global community recognizes the urgent need to end preventable child deaths, making it an essential part of global child survival goals and initiatives including the United Nations Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030)3 and the Sustainable Development Goals (SDGs).4 The third SDG calls for an end to preventable deaths of newborns and children under age 5, with all countries aiming to reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births and under-five mortality to at least as low as 25 deaths per 1,000 live births by 2030.
Sound policies, concerted efforts and appropriate resources are needed to accelerate progress and achieve the child survival goals. If current trends continue, 53 countries will not meet the SDG target on under-five mortality by 2030. This would result in 11 million excess child deaths between 2019 and 2030 in addition to the 41 million children who will die before age 5 between 2019 and 2030, even if all countries meet the SDG target by 2030.
Protecting every child’s right to survive will require addressing persistent inequities and disparities in maternal and child health while also ensuring universal access to safe, effective, high-quality and affordable care for women, children and adolescents. It also demands great understanding of levels and trends in child mortality, as well as the underlying causes of child and young adolescent deaths to help guide policymaking and planning.
Given the absence of reliable vital registration data in many countries – an important resource for monitoring births and deaths – evidence-based estimation of child mortality remains a cornerstone for tracking progress towards child survival goals. These estimates enable governments, international organizations and other stakeholders to set priorities and plan national and global health strategies and interventions. The United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME) produces estimates of child and young adolescent mortality annually, reconciling the differences across data sources and taking into account the systematic biases associated with the various types of data on child and adolescent mortality. This report presents the UN IGME’s latest estimates – through 2018 – of neonatal, infant and under-five mortality as well as mortality among children aged 5–14 years. It assesses progress in the reduction of child and young adolescent mortality at the country, regional and global levels, and provides an overview of the methods used to estimate the mortality indicators mentioned above.
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