The United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME) released estimates in January 2023 that revealed that approximately 5 million children died before their fifth birthday in 2021. Furthermore, around 2.1 young people aged 5-24 lost their lives. The WHO states that “many of these deaths could have been prevented with equitable access and high-quality maternal, newborn, child, and adolescent health care”.  

Vidhya Ganesh, UNICEF’s Director of the Division of Data Analytics, Planning, and Monitoring said that “too many parents are facing are facing the trauma of losing their children, sometimes even before their first breath”.  

“Such widespread, preventable tragedy should never be accepted as inevitable. Progress is possible with stronger political will and targeted investment in equitable access to primary health care for every woman and child.” 

Limited progress 

Although there is a lower risk of death across all ages since 2000, due to greater investment, the rate of progress has decreased since 2010. 54 countries will fail to meet the Sustainable Development Goals target for under-5 mortality. It is feared that without swift action, almost 59 million children and young people will die before 2030.  

Location lottery 

As expected, a child’s place of birth has a significant bearing on its chance of survival. The UN emphasises that “timely, high-quality, and disaggregated data” are critical to tackling preventable deaths, but “data of this nature are more the exception than the rule”. It reports that only 36 countries have high-quality data for 2021, while about half of the world’s countries have “no data on child mortality in the last five years”.  

From the data that we do have, it is tragically clear that the “immense, intolerable, and mostly preventable loss of life was carried unequally” across the world. By contrast to the global under-five mortality rate (U5MR) of 38 deaths per 1,000 live births in 2021, children born in sub-Saharan Africa were at highest risk of childhood death with a U5MR of 74 deaths per 1,000 live births. This is 15 times higher than the risk for children in Europe and Northern America.  

Dr Anshu Banerjee, Director for Maternal, Newborn, Child, and Adolescent Health and Ageing at WHO, described it as “grossly unjust that a child’s chances of survival can be shaped just by their place of birth”.  

“Children everywhere need strong primary health care systems that meet their needs and those of their families, so that – no matter where they are born – they have the best start and hope for the future.”  

Why are we falling behind? 

Juan Pablo Uribe, Global Director for Health, Nutrition, and Population, World Bank, and Director of the Global Financing Facility, identified “millions of children and families who are denied their basic rights to health”.  

“We need political will and leadership for sustained financing for primary care which is one of the best investments countries and development partners can make.”  

Access, as always, is a life-or-death issue for children. Many of the reasons that these children are dying are preventable, and WHO suggests that although COVID-19 has “not directly increased childhood mortality”, it may have “increased future risks to their survival”. The report identifies concerns around disrupted vaccination campaigns among other risks.  

“Notably, disruptions to certain interventions like vaccination or nutrition may particularly affect the 1-59 months portion of under-five mortality, because children in this age group tend to be more susceptible to infectious disease as a cause of death relative to older ages.”

To read the full report click here. For more on routine and specific vaccination campaigns that contribute to early years survival, get your tickets to the World Vaccine Congress in Washington this April.