In 2021, an estimated five million boys and girls died before their fifth birthday together with some 2.1 million counterparts aged between five and 24 years, according to the latest estimates by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME).

A second report found that 1.9 million babies were stillborn during the same period.  Many of these deaths could have been prevented with equitable access and through the provision of higher quality maternal, newborn, adolescent and child healthcare.

Progress is possible

UN IGME was established in 2004 to share data on child mortality and report on global progress towards child survival goals, among other objectives. 

The group is led by the UN Children’s Fund (UNICEF) and includes the World Health Organization (WHO), the World Bank Group, and the Population Division of the UN Department of Economic and Social Affairs (UN DESA).

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

“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 healthcare for every woman and child.”

Life or death

Access to and availability of quality healthcare continues to be a matter of life or death for children globally, the group said.

Most child deaths occur before the age of five, and half are within the very first month of life. For these babies, premature birth and complications during labour, are the leading causes of death. 

Similarly, more than 40 per cent of stillbirths occur during labour, though most are preventable when women have access to quality care throughout pregnancy and childbirth. 

For children that survive past their first 28 days of life, infectious diseases like pneumonia, diarrhoea and malaria are the biggest threat.

Progress and pitfalls

The reports also show how greater investments in strengthening primary health systems have benefited women, children and young people.

The global under-five mortality rate has fallen by half since the year 2000, while mortality rates in older children and youth, dropped by 36 per cent and the stillbirth rate decreased by 35 per cent.

However, gains have reduced significantly since 2010, and 54 countries will fall short of meeting the Sustainable Development Goals (SDG) target for under-five mortality. 

It calls for ending preventable deaths of newborns and under-fives by 2030, with all countries aiming to reduce neonatal mortality to at least 12 per 1,000 live births, and under-five mortality to as low as 25 per 1,000 live births.

Millions more at risk

The reports warn that unless swift action is taken to improve health services, nearly 59 million children and youth will die before the end of the decade, and nearly 16 million stillbirths will likely occur.

“It is grossly unjust that a child’s chances of survival can be shaped just by their place of birth, and that there are such vast inequities in their access to lifesaving health services,” said Dr Anshu Banerjee, Director for Maternal, Newborn, Child and Adolescent Health and Ageing at WHO. 

Even today, children still face “wildly differentiating chances of survival” depending on where they were born, with sub-Saharan Africa and Southern Asia shouldering the heaviest burden.

A worthwhile investment

Although sub-Saharan Africa had just 29 per cent of global live births, the region accounted for 56 per cent of all under-five deaths in 2021, and Southern Asia, 26 per cent.

Children born in sub-Saharan Africa also have the highest risk of childhood death in the world – 15 times higher than those in Europe and North America.

Meanwhile, mothers in sub-Saharan Africa and Southern Asia, experience the painful loss of stillbirth at an exceptional rate. 

In 2021, 77 per cent of all stillbirths occurred in these regions, and nearly half of all stillbirths happened in sub-Saharan Africa. The risk of a woman having a stillborn baby there, is seven times more likely than in Europe and North America.

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

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

COVID-19 future impact

While the COVID-19 pandemic has not directly increased childhood mortality, it may have increased future risks to their longer-term survival, according to the reports.

Disruptions to vaccination campaigns, nutrition services, and access to primary healthcare could jeopardize child health and well-being for many years to come, according to the reports. 

Furthermore, the pandemic has also sparked the largest continued backslide in vaccinations in three decades, putting the most vulnerable newborns and children at greater risk of dying from preventable diseases. 

Reduce inequities, end deaths

The two reports are the first of a series of important data sets, with UN maternal mortality figures set to be published later in the year.

Even though they highlight the remarkable global progress since 2000 in driving down under-five mortality, more work is still needed, said John Wilmoth, Director of the UN DESA Population Division.

“Only by improving access to quality healthcare, especially around the time of childbirth, will we be able to reduce these inequities and end preventable deaths of newborns and children worldwide,” he said.