The Levels & Trends in Child Mortality Report, 2020 was released in September 2020 by the UN Inter-agency Group for Child Mortality Estimation (UN IGME). Based on the estimates of UN IGME data, this annual report brings out full scope of child mortality rates across the world—from newborns to adolescents. It also evaluates the progress made towards meeting the sustainable development goal (SDG) targets by 2030. This report, for the first time, also estimates mortality rates of youth, aged between 15 and 24 years. The report presents the latest and updated estimates through 2019, assessing the progress or reduction of child, adolescent, and youth mortality at the national, regional, and global levels.
According to the report, meeting the SDG child survival targets on under-five would save 11 million lives, including more than half in sub-Saharan Africa. However, based on the current trends (2010–2019), 53 countries will miss the target for under-five mortality, 25 or fewer deaths per 1,000 live births by 2030. When it comes to achieving the target of reducing neonatal mortality (12 or fewer deaths per 1,000 live births), 60 countries are expected to miss the goal by 2030. Also, based on the current trends, (2016-2019), 24 million newborns would die between 2020 and 2030, and 80 per cent of these deaths would occur in sub-Saharan Africa and South Asia. Accelerating progress in approximately 60 countries to achieve the SDG target on neonatal mortality would save the lives of 5 million newborns from 2020 to 2030.
The estimates and analysis of the report act as the base to monitor changes in mortality pattern, the world over.
Major Findings
- Despite a global decline in child and youth mortality in the last three decades (1990–2019)—about 60 per cent decline in under-five mortality was observed, while there is a 52 per cent drop in neonatal mortality in the same period of time. In this speed the world will fail to achieve targets set under the SDGs.
- All over the world, a child born today has a better chance at surviving to age five in comparison with those born in 1990.
- Since 1990, global under-five years mortality rate declined to 38 deaths per 1,000 live births in 2019. It was 93 and 76 in 1990 and 2000 respectively. Globally, the annual rate of reduction in under-five mortality rate doubled from 1.9 per cent in 1990–1999 to 4.0 per cent in 2000–2009, before slowing slightly to 3.4 per cent in 2010–2019. Worldwide, the number of global under-five deaths dropped to its lowest point in 2019, down to 5.2 million from 12.5 million in 1990. About 49 per cent of under-five deaths in 2019 occurred in just five countries—Nigeria, India, Pakistan, the Democratic Republic of Congo, and Ethiopia. India and Nigeria accounted for about one third of all under-five deaths in 2019.
- Between 1990 and 2019, 85 countries, including 34 low-income and lower middle-income countries, have reduced their under-five mortality rate by at least two thirds. While in 1990, more than 50 countries had an under-five mortality rate above 100 deaths per 1,000 live births, by 2019, the number was reduced to 5 deaths per 1,000 live births.
- Adolescents over five years and aged between 10–19 accounted for 1 million deaths, while children aged 5–9 accounted for 0.5 million, and youth aged 20–24 for 0.8 million.
- The report makes a startling revelation that the young people and older adolescents face an increasing risk of dying with age, newborns face the greatest risk of dying among children underage of five. The risk of mortality is highest during the first 28 days of life, the neonatal period.
- The risk of dying for a newborn in the first month of life is about 55 times greater in the highest mortality country than in the lowest mortality country.
- Although progress has been made in every age group, it has been uneven and largely based on country wealth. The sub-Saharan Africa continues to suffer where for 1000 live births the under-five mortality rate stands at 76 deaths as of 2019. This means, one child in 13 dying before reaching age five and the region is 20 years behind the world average. All the five countries, where morality rates above 100 deaths per 1,000 live births, are in sub-Saharan Africa. In 2019, sub-Saharan Africa carried more than half of child mortality burden with 2.8 million children under-five deaths (53 per cent) at 27 deaths per 1,000 live births. This was followed by Central and South Asia with 1.5 million (28 per cent) at 24 deaths per 1,000 live births.
- In 21 out of 48 countries in sub-Saharan Africa, the number of neonatal deaths did not decline from 1990 to 2019, and overall, neonatal deaths have stagnated at about 1 million annually in the region.
- Sub-Saharan Africa accounts for 44 per cent of deaths between the age five and 24.
- The regions of central and South Asia and Oceania, excluding Australia and New Zealand, saw a faster decline in under-five mortality from 2010–2019 compared to 2000–2009.
- worldwide infectious diseases like pneumonia, diarrhoea, and malaria have remained as a leading cause of under-five deaths, whereas preterm birth and intrapartum complications are adding more problems.
- Access to life-saving interventions, such as childbirth delivery care, postnatal care, vaccination, and early childhood preventative and curative services, have always been critical for ensuring steady mortality declines in low- and middle-income countries.
- The gap between the highest and lowest regional under-five mortality rates has lessened over time from a difference of 171 deaths per 1,000 live births in 1990 to 73 in 2019. In 2019, the under-five mortality rate, in the 36 countries which were classified as ‘fragile’ by World Bank was almost three times higher than that in ‘non-fragile’ countries. The annual rate of reduction for the last decade (2010– 2019) in fragile countries was 25 per cent slower than the world average—2.6 per cent in fragile countries, compared to 3.4 per cent globally. This means 26 of the 36 countries, classified as ‘fragile’, are at risk of missing the SDG target for under-five mortality by 2030.
- On an average, boys are expected to have a higher probability of dying before reaching age five than girls. However, in countries primarily located in South Asia and West Asia, the number is higher for girls.
- For countries that have already achieved the SDG target, further reductions in child mortality could be achieved by eliminating inequities across several dimensions like household income, race and ethnicity, and sub-national divisions.
- The neonatal mortality rate declined more slowly than mortality among children aged 1–59 months. Across all major SDG regions, the annual rate of reduction from 1990 to 2019 was larger for children aged 1–59 months than for neonates. The share of neonatal deaths among all under-five deaths increased from 40 per cent in 1990 to 47 per cent in 2019.
- The report suggests that by maintaining high coverage of quality antenatal care, skilled care at birth, postnatal care for mother and baby, and care of small and sick newborns, the situation can be improved.
- For children, adolescents, and youth aged 5–24 years, the risk of dying has been lowest for children aged between 10 and 14. The risk of dying at any age between 5 and 24 is lower than for children under 5 years of age. As per estimate, 6,100 children and young people, aged between 5 and 24, died every day in 2019. However, since 1990, the mortality rate for children and youth (5–24 years) declined by 43 per cent globally but the adolescent mortality, encompassing ages 10–19, declined by nearly 40 per cent since 1990. If the same trend continues, 23 million children and youth aged 5–24 years would die between 2020 and 2030, and 44 per cent of those deaths are projected to take place during the adolescent period. Around 71 per cent of the global deaths at ages 5–24 years from 2020 to 2030 would occur in just two regions: sub-Saharan Africa (10.8 million) and South Asia (5.3 million).
About UN IGME
The UN IGME formed in 2004, shares data on child mortality, improving methods for child mortality estimation, reports on progress towards child survival goals, and enhancing country capacity to produce timely and properly assessed estimates of child mortality. The UN IGME is led by the UNICEF and includes the World Health Organization (WHO), the World Bank Group, and the United Nations Population Division of the Department of Economic and Social Affairs as full members.
Its independent Technical Advisory Group (TAG) comprises leading academic scholars and independent experts in demography and biostatistics. They provide guidance on estimation methods, technical issues, and strategies for data analysis and data quality assessment. It updates its child mortality estimates annually after reviewing newly available data and assessing data quality.
- Among children adolescents, and youth (5–24 years), the leading causes of death are injury, including road accidents and drowning, interpersonal violence, and self-harm.
- Sex differences in cause of death emerge during the adolescent period also. male death rates tend to be higher on account of mortality from collective violence in addition to causes mentioned above.
- A major cause of death among young women is maternal conditions.
COVID-19 and child survival Countries worldwide are now experiencing disruptions in child and maternal health services, such as health checkups, vaccination, prenatal, and postnatal care, due to lack of resources and hesitancy in accessing health services due to fear of contracting COVID-19.
There is insufficient data to fully assess COVID-19 related mortality and morbidity in children, adolescents, and young people across geographical regions, race, ethnicity, and age. According to the Executive Director of UniCEF, “the global community has come too far towards eliminating preventable child deaths to allow the COVID-19 pandemic to stop us in our tracks.”
Findings on India
India’s child mortality rate (under 5) has declined from 3.4 million in 1990 to 8,24,000 in 2019. The under-five mortality rate in India has declined to 34 per thousand in 2019 from 126 in 1990. The sex-specific under-five mortality rate, deaths per 1000 live births, in 1990 stood at 122 males and 131 females and this declined to 34 males and 35 females in 2019. The country witnessed a 4.5 per cent annual rate of reduction in under-five mortality between 1990–2019.
Infant mortality rate, deaths per 1,000 live births, declined from 89 in 1990 to 28 in 2019. The country registered 6,79,000 infant deaths in 2019, showing a significant decline from 2.4 million infant deaths in 1990. India registered a decrease in neonatal mortality rate between 1990 and 2019 from 57 to 22—1.5 million neonatal deaths in 1990 to 5,22,000 deaths in 2019.
Over the past three decades, health services to prevent or treat causes of child death such as preterm, low birth weight, complications during birth, neonatal sepsis, pneumonia, diarrhoea, malaria, and vaccination played a major role in saving millions of lives.
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