The Millennium Development Goal 4 has only one target:
- To reduce the under-five mortality rate by two-thirds in the period between 1990 and 2015
Undernutrition is estimated to contribute to more than 33 percent of all deaths in children under five. So, efforts to improve household food security and nutrition have increased the chances of children growing to adulthood.
In this regard, FAO programmes, in combination with efforts by the Renewed Efforts against Child Hunger and Undernutrition (REACH) and WHO, WFP, and UNICEF have helped communities and households secure access to nutritionally adequate diets to minimise child undernutrition. Efforts include the provision of training materials, community-centred initiatives, training programmes for local and national staff, nutrition education programmes, and promotion of forums on community nutrition and household food security.
Improving complementary feeding for babies, or giving foods in addition to breast milk, has led to significant reduction in the child mortality caused by undernutrition.
Some of the achievements of MDG 4 include:
- A decrease in worldwide rate of mortality in children under-five by over 50 percent, reducing from 90 to 43 deaths per 1,000 live births between 1990 and 2015.
- A global drop in the number of children under-five deaths from 12.7 million in 1990 to nearly 6 million in 2015, despite the population growth in developing regions.
- Three-fold increase in the rate of reduction of under-five mortality since the early 1990s.
- In sub-Saharan Africa, the annual rate of reduction of under-five mortality was more than five times between 2005 and 2013 compared to between 1990 and 1995
- The measles vaccination helped prevent almost 15.6 million deaths between 2000 and 2013, translating to a 67 percent decline in the number of cases of measles reported globally.
- Nearly 84 percent of children across the globe received at least one dose of measles containing vaccine in 2013 – a 73 percent increase since 2000
A broader look at the reduction of child mortality
The incredible drop in preventable child deaths in the last 25 years is truly one of the most significant achievements in human history. Preliminary estimates suggest that universal under-five mortality has dropped by more than 50 percent – from 90 to 43 deaths per 1,000 live births in that period. This translates to a major decline from 12.7 million deaths of children under five in 1990 to 6 million in 2015. Only Oceania has not achieved over 50 percent reduction in under-five mortality compared to other developing regions.
Despite the achievements in most developing regions, the current trend is not sufficient to meet the MDG target for at least another 10 years. The universal advance in child survival is still elusive to many of the globe’s youngest children – as well as those in the most vulnerable situations. About 16,000 children under five continue to die every day in 2015, mostly due to preventable causes like pneumonia, malaria, and diarrhea. Another one million of the 6 million children who die before their fifth birthday take their first and last breath on the day they’re born. Another 1 million will die in the first week, and around 2.8 million will die within their first 28 days of life (the neonatal period).
In the last 25 years, the universal neonatal mortality rate has dropped from 33 to 19 deaths per 1,000 live births, though this rate has been slower than the decline in mortality for children aged 1-59 months. Most neonatal deaths are caused by preterm birth complications (35 percent), complications during labor and pregnancy (24 percent), and sepsis (15 percent).
In Southern Asia and sub-Saharan Africa, many deaths are also attributed to preventable infectious diseases and could be avoided with simple, high-impact, and cost-effective interventions.
Other causes of child mortality
- Mother’s education and residence – children in rural areas are 1.7 times more likely to die before their fifth birthday compared to those in urban areas. This is mostly attributed to the mother’s education, with children born of mothers with secondary or higher education nearly 3 times as likely to survive as those of mothers with no education. That said, mortality among the poorest households has been declining rapidly, probably due to the improving equality.
- Measles – deaths caused by measles have declined rapidly between 2000 and 2015, from 544,200 to 145,700 deaths, mostly among children under five. Estimates suggest that nearly 15.6 million deaths were averted by measles vaccinations administered between 2000 and 2013, though sub-Saharan Africa and Southern Asia are still the most affected by measles deaths.
Reducing the mortality of children-under-five requires sound strategies, adequate resources, and political will. The MDGs have led to amazing, unprecedented gains in reducing child deaths, through improved service delivery, effective and affordable treatments, and political commitment.
The achievement of MDG 4 by most developing countries shows that it can be done. And with 11 children dying every minute around the world before celebrating their fifth birthday, more needs to be done to improve child survival rates.
What are MDGs 4 and 5 all about?
MDG4 aims to reduce child mortality, while MDG5 is focused on improving maternal health.
The child health goal has one target: to reduce the under-five mortality rate by two-thirds by 2015. At its inception in 2000, the maternal health goal was also limited to a single target : to reduce the maternal mortality ratio by three-quarters. In 2005, global leaders added an additional target to achieve universal access to reproductive healthcare. Progress on th e latter is measured by the prevalence of contraception, adolescent birth rate, antenatal care coverage and the unmet need for family planning, which refers to the number of women who want but do not have access to contraception.
Will the child health goal be met?
There has been substantial progress in reducing child mortality over the past 15 years, but not enough to achieve the goal of a reduction by two-thirds. Between 1990 and 2012, the child mortality rate almost halved, meaning that 6 million fewer children died in 2012 than in 1990. But while child mortality rates ha ve fallen, progress has been too slow. According to UN figures, it would take until 2028 to achieve MDG4 globally. Less than one-third of all countries have achieved or are on track to meet the goal by the end of this year.
What are the leading causes of child death ?
Globally, the most dangerous day in a child’s life is the day it is born. Data indicate that preterm birth complications are now the leading cause of under-five deaths, accounting for 17% of all deaths in this age group. Prematurity, which applies to babies born alive before 37 weeks of pregnancy , is a global problem that is increasing in almost all countries with reliable data. The majority of premature babies in high-income countries survive, but a lack of basic and cost-effective care such as breastfeeding support, warmth and treatment for infections means the chance of survival is reduced in low-income countries. Also, women who were undernourished during their own childhood and pregnancy are more likely to deliver babies who are preterm or small at birth.
Other leading causes of under- five mortality are pneumonia, diarrhoea and birth asphyxia – a failure to establish breathing at birth. Between 2000 and 2012, deaths due to measles fell by 80% and there were also considerable reductions in deaths due to HIV and Aids (-51%), diarrhoea (-50%), pneumonia (-40%) and malaria (-37%). In contrast, relatively little progress was made in reducing the number of deaths due to prematurity, which had a decline of only 14%.
Will the maternal health goal be met?
The world is likely to fall far short of the targeted 75% reduction in the number of women dying due to complications from pregnancy or childbirth by 2015. The data collected so far is from 1990 to 2013, and shows a 45% drop in the global maternal mortality rate. The World Bank says that, of the eight millennium development goals, the one on maternal health has made the least progress. Sub-Saharan Africa had the highest maternal mortality ratio of developing regions, with 510 deaths for every 100,000 live births, followed by southern Asia, Oceania and the Caribbean.
The reproductive health target is a similar story of progress achieved at too slow a rate. The number of women in developing countries who saw a skilled birth attendant at least once during their pregnancy increased from 65% in 1990 to 83% in 2012, but only half of those women received the recommended four antenatal check-ups. Access to antenatal care differs widely from region to region – 80% of women in south-east Asia and the Caribbean reported at least four antenatal care visits, compared with 50% in sub-Saharan Africa and only 36% in southern Asia.
Improved access to safe, affordable and effective methods of contraception has led to an increase in its use. In sub-Saharan Africa, the proportion of women between the ages of 15 and 49 who were using contraception doubled between 1990 and 2012, from 13% to 26%. Tthe unmet need for family planning has decreased, but the issue remains problematic. In sub-Saharan Africa in 2012, 25% of women aged 15 to 29 who were married or in a partnership and wanted to avoid or delay pregnancy did not have access to any form of contraception.
What still needs to be addressed?
While significant progress has been made in tackling child mortality, experts say closer attention must be paid to growing inequalities within countries. In its report, The Lottery of Birth, Save the Children found that country-level statistics on child mortality often masked inequalities between different social and economic groups, including children from the poorest sections of society, those from disadvantaged regions, those from rural areas and those belonging to ethnic minorities.
Campaigners argue that women’s sexual and reproductive rights must be at the centre of any discussion about maternal and reproductive health. Women’s rights groups say that provision of health services is not enough . They argue that girls and women must have the ability to decide if, when and how many children they have, and to have control of the reproductive healthcare services they receive.
How do MDG4 and 5 fit into the next set of goals ?
The sustainable development goals, set to replace the MDGs next year, will aim to resolve the unfinished business of the maternal and child health MDGs and drive further progress. The three health-related MDGs, which focus on child health, maternal health and diseases, will merge into one sustainable development goal to “ensure healthy lives and promote wellbeing for all at all ages”. The 13 proposed targets include an aim to reduce the global maternity mortality ratio to less than 70 for every 100,000 live births. The goal also includes a target to end all preventable deaths of newborns and under-five children.