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A Child Survival Report Card: Number 1, 2004 View All Reports >
South Asia: Under-five
Every one of the nine countries in South Asia has made progress in reducing child mortality rates since 1990. But some still struggle to attain the required pace of reduction.

Where the children are
India’s one billion plus population, together with young and large populations in Bangladesh and Pakistan, means that the region has the world’s second largest population of children. Of the three countries, only Bangladesh, with a lower rate of child mortality than either India or Pakistan, is on track to meet MDG 4. It reduced under-five deaths to almost half of its 1990 level by 2002, at an average annual rate of reduction of 5.2 per cent.

In contrast, the slowdown in child mortality reduction seen in India and Pakistan in the 1990s has left them lagging behind. India must accelerate its annual rate of reduction to over 6 per cent to meet MDG 4, and for Pakistan, the required rate is 7 per cent.

Other countries
Of the remaining countries in the region, only Bhutan is on schedule to meet MDG 4. While Nepal is not far behind, the Maldives and Sri Lanka will have to intensify their efforts. Child mortality in Afghanistan was virtually unchanged in 2002 compared with 1990, and although the situation is likely to have improved in the past year, the country is still facing the daunting challenge of reducing child deaths by 8 per cent a year to achieve MDG 4.

The causes
In South Asia, poor perinatal care is the leading reason for children under five dying, accounting for almost one third of all their deaths. Acute respiratory infections and diarrhoea are the other main killers. In proportionate terms, diarrhoea as a single proximate cause of child deaths is at its worst in the South Asia region.

According to the latest available statistics, HIV/AIDS is not yet a major cause of child mortality in the region; only 1 per cent of deaths are linked to the disease. However, rates of HIV infection are likely to increase in the coming years, adding to the burden faced by the region in its attempts to reduce child mortality.

South Asia
CountryU5MR 1990U5MR 2002MDG target(a) 2015Progress(b) 1990-2002Requirement 2002-2015
Afghanistan 260 257 87 0.1 8.4
Pakistan 130 107 43 1.6 7.0
Sri Lanka 23 19 8 1.6 6.9
India 123 93 41 2.3 6.3
Maldives 115 77 38 3.3 5.4
Nepal 145 91 48 3.9 4.9
Bhutan 166 94 55 4.7 4.1
Bangladesh 144 77 48 5.2 3.6

Countries whose AARR has matched or exceeded the implied MDG target in 1990-2002 are shown as shaded.


Millennium Development Goal 4 set each country the task of reducing the under-five child mortality rate by two thirds between 1990 and 2015.


The speed of progress in reducing the U5MR is measured here by calculating the average annual reduction rate (AARR). Unlike the comparison of absolute changes, the AARR reflects the fact that the lower limits to U5MR are approached only with increasing difficulty. The AARR is calculated on an exponential basis, which assumes a continuous, exponential reduction between two points in time. It does not take into account the intermediate values of the series. To achieve a two-thirds reduction between 1990 and 2015 requires a progress rate of 4.4 per cent or higher.

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