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The big picture

© UNICEF/ HQ98-0503/ Pirozzi
A child who suffers from severe malnutrition, rests his hand in his mother's palm at a supplementary feeding centre. Sierra Leone.

The world reached an important milestone in child survival in 2012 with new estimates showing a 47 per cent  decline in the under-five mortality rate, from 90 deaths per 1,000 live births in 1990, to 48 deaths per 1,000 live births in 2012. However, the loss of 18,000 children under age five every day in 2012 is unacceptable, especially when many of these deaths are preventable. And the world is not yet on track to achieve the Millennium Development Goal target of a two-thirds reduction in the rate of child mortality by 2015. 

Many of those who do survive are unable to grow and develop to their full potential. Most deaths result from five causes, or a combination of them: pneumonia, preterm birth complications, intrapartumrelated complications (complications during birth), diarrhoea and malaria. Poverty and the failure to ensure universal access to basic social services are to blame.

Complications related to pregnancy and childbirth killed 287,000 women in 2010 – one almost every two minutes – and injure and disable many more.

Together with governments, humanitarian agencies, civil and community leaders, families and children themselves, UNICEF is addressing these threats.

Impressive progress has been made in improving the survival rates and health of children, even in some of the poorest countries. Of the 61 high-mortality countries - those with at least 40 deaths per 1,000 live births in 2012 - 25 have reduced their under-five mortality rate by at least half between 1990 and 2012.

  • The global rate of under-five mortality has roughly halved (47%), from 90 deaths per 1,000 live births in 1990 to 48 per 1,000 in 2012. 
  • Global vaccination coverage trends continue to be positive with global coverage of the third dose of combined diphtheria/pertussis/tetanus (DPT3) vaccine around 83%.
  • The combination of improved routine measles coverage and follow up campaigns has steeply reduced the number of measles deaths: by 71% between 2000-2011 worldwide from estimated 548,300 to 157,700.
  • Progress on vitamin A supplmentation has been outstanding. In 2011, 54 countries reported on two-dose coverage for children under five and of these, 37 countries attained at least 70% coverage.   
  • Increased global awareness of malaria contributed to a significant increase in resources, allowing a rapid scaling-up of malaria interventions. As a result, the use of insecticide-treated bed nets in sub-Saharan Africa significantly increased: the proportion of households in sub-Saharan Africa owning at least one ITN increased dramatically from 3% in 2000 to 53% in 2011, and remained at 53%. The estimated proportion of the population that sleeps under an ITN, although lower than the proportion owning at least one ITN, has also increased since 2000, reaching 33% in 2012.

Despite this encouraging progress, immense obstacles continue to stand in the way of ensuring that every child gets the best start in life. The HIV/AIDS pandemic has reached catastrophic proportions in several parts of the world, unraveling decades of hard-won gains in child survival and development, especially in sub-Saharan Africa.

Armed conflicts that kill and injure children are proliferating and chronic poverty remains the greatest obstacle to fulfilling the rights of children.  Infant and child mortality rates are also the highest in countries ravaged by civil strife, weak governance and chronic underinvestment in public health systems and physical infrastructure. Similarly, fragile states, characterized by weak institutions with high levels of corruption, political instability and a shaky rule of law, are often incapable of providing basic services to their citizens.

Gender inequity and discrimination persist. Millions of women and children have been excluded from progress in recent decades because they are poor. The inequalities in child survival between poor and better-off children are stark, not only between countries but within them. For countries with available data, children in the poorest 20% of households are far more likely to die before their fifth birthday than children living in the richest quintile.



State of the World's Children 2008

Progress for Children, 2007

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