Goal: Reduce child mortality

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Targets by 2015:

To reduce child mortality by two-thirds, from 87 children of every 1,000 dying before age five in 1990 to 29 of every 1,000 in 2015.

Child survival lies at the heart of everything UNICEF does.

About 19,000 children under the age of five – 13 each minute – die every day, mainly from preventable causes.

In 2011, nearly 7 million children died before age five, as compared to 1990 when nearly 12 million did. While that translates into 14,000 fewer children dying every day in 2011 than in 1990, it still translates into the deaths of 19,000 children under age five every day in 2011.

The global under-five mortality rate stands at 51 deaths per 1,000 live births in 2011, a drop of 41 per cent from 87 per 1,000 in 1990. But the world as a whole is still far from the goal of 29 by 2015.

Five countries account for around half of all child deaths: India, Nigeria, the Democratic Republic of Congo, Pakistan and China. India (24 per cent) and Nigeria (11 per cent) together account for more than a third of all under-five deaths. More than four-fifths of all under-five deaths in 2011 occurred in sub-Saharan Africa and Southern Asia.  These regions will account for the bulk of the world’s births in the next years.

And the bulk of the global under-five deaths are preventable.  Two-thirds of the deaths occur from infectious diseases. About 40% of under-five deaths occurred within the first month of life. During post-neonatal period, pneumonia, diarrhoea and malaria are the main killers of children. Many of the deaths occur in children already weakened by undernutrition; worldwide, more than a third of all under-five deaths are attributable to this condition. But disease isn’t inevitable, nor do children with these diseases need to die. With vaccines, adequate nutrition and basic medical and maternal care, most of these young lives could be saved.

These measures are the basis for UNICEF’s actions to help children survive, carried through with hundreds of allies and via offices in the field – and well-travelled staff – all over the world.

UNICEF responds by:

Providing high-impact health and nutrition interventions. In partnership with governments, WHO and others, UNICEF aims to scale up proven, high-impact, cost-effective health and nutrition interventions to reduce the number of neonatal and young child deaths from preventable and easily treatable causes.

UNICEF is the world’s largest purchaser of vaccines, procuring more than 40 per cent of all vaccines used in the developing world. While global immunization rates have risen from less than 20 per cent in the 1970s to about 74 per cent in 2002, millions of children must still be reached. UNICEF negotiates favourable prices and forecasts vaccines requirements to ensure sustainable supplies. Targets include increasing immunization coverage to at least 90 per cent at the national level and 80 per cent in all districts, with particular focus on reaching population groups with low coverage levels, and the final eradication of polio.

When delivering vaccines UNICEF adds micronutrient supplements to offset malnutrition, another critical factor in child survival. Supplements of vitamin A taken every four to six months can reduce child mortality from all causes by as much as 23 per cent, measles deaths by 50 per cent and deaths from diarrhoea by 33 per cent.

Another target in this area is increasing the rate of children sleeping under mosquito nets to at least 60 per cent in malaria-endemic areas. Malaria is responsible for 7 per cent of all under-five deaths in in the world.

According to the World Health Organization (WHO), poor neonatal conditions are the most prominent cause of young deaths. Three million babies died in the first month of life in 2011. In response, UNICEF advocates for and promotes programmes to increase rates of exclusive breastfeeding. The strongest foundation of baby health is nutrition, and the best food for newborns is breast milk. Breastfeeding protects babies from diarrhoea and acute respiratory infections, stimulates their immune systems and improves response to vaccinations, and contains many hundreds of health-enhancing molecules, enzymes, proteins and hormones.

A mother’s health is also critical to newborns, particularly in light of new research that suggests a sound neonatal environment is an important predictor of future health. Together with the WHO and United Nations Population Fund (UNFPA), UNICEF advocates and lends technical and financial support to comprehensive community health programs for expectant women. This would ideally include providing micronutrient supplements, vaccines, anti-malarial drugs and insecticide-treated bed nets.

Improving family care practices. About 80 per cent of health care in developing countries occurs in the home – and the majority of children who die do so at home, without being seen by a health worker. Meanwhile, proper infant feeding and breast feeding are still not practiced by many families. As many as 40 per cent of child deaths could be prevented with improved family and community care – not high-tech health equipment, but access to solid knowledge, support and basic supplies.

Working with governments, health providers and communities in the field, UNICEF helps families learn essential skills and basic health knowledge, particularly in the care of newborns. This includes best practices in breastfeeding and complementary feeding, hygiene and safe faeces disposal.

UNICEF also works for better integration among systems that deliver basic supplies and health services to the poorest families. Health and outreach workers are enabled to support better parenting, the care of mothers, infant feeding, care-seeking practices among families and communities in favour of disease prevention, and optimal management of childhood illness.

These include treatment for diarrhoea, including the use of oral re-hydration salts, and for acute respiratory infections such as pneumonia.

Increasing access to improved water and sanitation. UNICEF helps develop systems to control water-borne diseases like Guinea worm and cholera that undermine child survival and development, reduce productivity and raise health-care costs. Struggles to find water and hygiene resources also primarily increase burdens on girls and women.

Working closely with governments, UNICEF also helps strengthen policies and budgets and support technical capacities in programmes for hygiene promotion, sanitation, cost-effective water supply options and water quality, particularly for poor rural and urban families. These activities also aim toward fulfilling Millennium Goals 4 and 7.

UNICEF also helps develop partnerships that pool competencies and resources, particularly in its role as advocate, facilitator and coordinator in emergencies.

Responding rapidly to emergencies. UNICEF is also one of the first aid organizations on the scene following the outbreak of a crisis, helping to establish monitoring systems, organize partnerships and provide vaccinations and vitamin A supplementation. UNICEF also helps fund and build fresh water and sanitation facilities, helping stem the spread of water-borne diseases.

By providing supplies, personnel and assistance with facilities and sanitation, UNICEF also helps get children Back to School, which supports a number of Goals. As well as being registered and accounted for, and supervised by adults, children can also access health care, food and sanitation resources at a school.

Progress

The world has made great strides in child survival. More children now survive their fifth birthday than ever before – the global number of under-five deaths has fallen from around 12 million in 1990 to an estimated 6.9 million in 2011. In the last decade alone, the world made significant progress, with the annual rate of decline in the global under-five mortality rate rising from an estimated 1.8 per cent in 1990-2000 to approximately 3.2 per cent in 2000-2011.

Significant progress has been achieved in tackling some major childhood diseases: Measles deaths have plummeted since 2000. Deaths from pneumonia, diarrhoea and malaria, have also fallen. Polio, though stubbornly resistant thus far to elimination, has fallen to historically low levels. Routine immunization has increased almost everywhere. Among the most striking advances is the progress in combatting AIDS.

But progress in meeting this Millennium Goal is the most off-track of any. As of 2011, four of ten regions are not on track to meet the Millenium Goal. This is particularly so in sub-Saharan Africa, where 1 in 9 children dies before the age of five, and Southern Asia, where that figure is 1 in 16. 144 countries are on track to meet the Goal but 51 countries lag far behind. There are still 24 countries where at least 1 in every 10 children dies before his or her fifth birthday, 23 of them in sub-Saharan Africa. This means that there remains much unfinished business as we approach the 2015 deadline – efforts must be intensified leading up to 2015 and the momentum sustained well beyond that.