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Levels & Trends in

ChildMortality

Report 2011Estimates Developed by theUN Inter-agency Group forChild Mortality Estimation

United NationsDESA/Population Division

This report was prepared at UNICEF Headquarters by Danzhen You, Gareth Jones and Tessa Wardlaw on behalf of theUnitedNations Inter‑agency Group for Child Mortality Estimation.Organizations and individuals involved in generating country-specific estimates on child mortalityUnited Nations Children’s FundDanzhen You, Tessa WardlawWorld Health OrganizationTies Boerma, Colin Mathers, Mie Inoue, Mikkel OestergaardThe World BankEmi SuzukiUnited Nations Population DivisionFrancois Pelletier, Gerhard Heilig, Kirill Andreev, Patrick Gerland, Danan Gu, Nan Li, Cheryl Sawyer, Thomas SpoorenbergUnited Nations Economic Commission for Latin America and the Caribbean Population DivisionDirk Jaspers Faijer, Guiomar Bay, Tim MillerSpecial thanks to the Technical Advisory Group of the Inter-agency Group for Child Mortality Estimation for providingtechnical guidance on methods for child mortality estimationKenneth Hill (Chair), Harvard UniversityLeontine Alkema, National University of SingaporeSimon Cousens, London School of Hygiene and Tropical MedicineTrevor Croft, Measure DHS, ICF MacroGareth Jones, ConsultantMichel Guillot, University of PennsylvaniaJon Pedersen, FafoNeff Walker, Johns Hopkins UniversityJohn Wilmoth, University of California, Berkeley

Further thanks go to Priscilla Akwara, Mickey Chopra, Archana Dwivedi, Jimmy Kolker, Richard Morgan, Holly Newby andIan Pett from UNICEF for their support as well as to Joy Lawn from Save the Children for her comments. And special thanks toMengjia Liang from UNICEF for her assistance in preparing the report.Communications Development Incorporated provided overall design direction, editing and layout.Copyright � 2011by the United Nations Children’s FundThe Inter‑agency Group for Child Mortality Estimation (IGME) constitutes representatives of the United Nations Children’sFund, the World Health Organization, the World Bank and the United Nations Population Division. The child mortality esti‑mates presented in this report have been reviewed by IGME members. As new information becomes available, estimates willbe updated by the IGME. Differences between the estimates presented in this report and those in forthcoming publicationsby IGME members may arise because of differences in reporting periods or in the availability of data during the productionprocess of each publication and other evidence. While every effort has been made to maximize the comparability of statisticsacross countries and over time, users are advised that country data may differ in terms of data collection methods, populationcoverage and estimation methods used.The designations employed and the presentation of the material in this publication do not imply the expression of any opinionwhatsoever on the part of UNICEF, the World Health Organization, the World Bank or the United Nations Population Divisionconcerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its fron‑tiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.On 9 July 2011 the Republic of South Sudan seceded from the Republic of the Sudan and was subsequently admitted to theUnited Nations on 14 July 2011; disaggregated data for Sudan and South Sudan as separate states are not yet available. Data andmaps in this report refer to Sudan as it was constituted in 2010.United Nations Children’s Fund3 UN Plaza, New York, New York, 10017 USAThe World Bank1818 H Street, NW, Washington, DC, 20433 USAWorld Health OrganizationAvenue Appia 20, 1211 Geneva 27, SwitzerlandUnited Nations Population Division2 UN Plaza, New York, New York, 10017 USA

PROGRESS TOWARDS MillEnniuM DEvElOPMEnT GOAl 4:KEY FACTS AnD FiGuRES• Overall, substantial progress has been made towards achieving MDG 4. The number of under-five deaths worldwide has declined from more than 12 mil-lion in 1990 to 7.6 million in 2010. Nearly 21,000 children under five died every day in 2010—about 12,000 fewer a day than in 1990. • Since 1990 the global under-five mortal-ity rate has dropped 35 percent—from 88 deaths per 1,000 live births in 1990 to 57 in 2010. Northern Africa, East-ern Asia, Latin America and the Carib-bean, South-eastern Asia, Western Asia and the developed regions have reduced their nder-five mortality rate by 50 per-ucent or more. • The rate of decline in under-five mortality has accelerated—from 1.9 percent a year over 1990–2000 to 2.5 percent a year over 2000–2010—but remains insuffi-cient to reach MDG 4, particularly in Sub-Saharan Africa, Oceania, Caucasus and Central Asia, and Southern Asia. • The highest rates of child mortality are still in Sub-Saharan Africa—where 1 in 8 children dies before age 5, more than 17 times the average for developed regions (1 in 143)—and Southern Asia (1 in 15). As under-five mortality rates have fallen more sharply elsewhere, the disparity be-tween these two regions and the rest of the world has grown. • Under-five deaths are increasingly con-centrated in Sub-Saharan Africa and Southern Asia, while the share of the rest of the world dropped from 31 per-cent in 1990 to 18 percent in 2010. • In Sub-Saharan Africa the average annual rate of reduction in under-five mortal-ity has accelerated, doubling from 1990–2000 to 2000–2010. Six of the fourteen best-performing countries are in Sub-Sa-haran Africa, as are four of the five coun-tries with the largest absolute reductions (more than 100 deaths per 1,000 live births). • About half of under-five deaths occur in only five countries: India, Nigeria, Dem-ocratic Republic of the Congo, Pakistan and China. India (22 percent) and Nigeria (11 percent) together account for a third of all under-five deaths. • Over 70 percent of under-five deaths occur within the first year of life.• The proportion of under-five deaths that occur within the first month of life (the neonatal period) has increased about 10 percent since 1990 to more than 40 percent.• Almost 30 percent of neonatal deaths occur in India. Sub-Saharan Africa has the highest risk of death in the first month of life and has shown the least progress.• Globally, the four major killers of chil-dren under age 5 are pneumonia (18 percent), diarrhoeal diseases (15 per-cent), preterm birth complications (12 percent) and birth asphyxia (9percent). Undernutrition is an underlying cause in more than a third of under-five deaths. Malaria is still a major killer in Sub-Saha-ran Africa, causing about 16 percent of under-five deaths.

IntroductionOnly four years remain to achieve MillenniumDevelopment Goal 4 (MDG 4), which calls forreducing the under-five mortality rate by two-thirds between 1990 and 2015. Since 1990 theunder-five mortality rate has dropped 35 percent,with every developing region seeing at least a 30percent reduction. However, at the global levelprogress is behind schedule, and the target is atrisk of being missed by 2015. The global under-five mortality rate needs to be halved from 57deaths per 1,000 live births to 29—that impliesan average rate of reduction of 13.5 percent ayear, much higher than the 2.2 percent a yearachieved between 1990 and 2010.Child mortality is a key indicator not only of childhealth and nutrition but also of the implemen-tation of child survival interventions and, morebroadly, of social and economic development. Asglobal momentum and investment for accelerat-ing child survival grow, monitoring progress atthe global and country levels has become evenmore critical. The United Nations Inter-agencyGroup for Child Mortality Estimation (IGME)updates child mortality estimates annually formonitoring progress. This report presents theIGME’s latest estimates of under-five, infant andneonatal mortality and assesses progress towardsMDG 4 at the country, regional and global levels.

The UN Inter-agency Group forChild Mortality EstimationThe IGME was formed in 2004 to share data onchild mortality, harmonize estimates within theUN system, improve methods for child mortal-ity estimation, report on progress towards theMillennium Development Goals and enhancecountry capacity to produce timely and prop-erly assessed estimates of child mortality. TheIGME, led by the United Nations Children’sFund (UNICEF) and the World Health Organiza-tion (WHO), also includes the World Bank andthe United Nations Population Division of theDepartment of Economic and Social Affairs asfull members.The IGME’s independent Technical AdvisoryGroup, comprising leading academic scholarsand independent experts in demography andbiostatistics, provides guidance on estimationmethods, technical issues and strategies for dataanalysis and data quality assessment.Generating accurate estimates of child mortal-ity poses a considerable challenge because of thelimited availability of high-quality data for manydeveloping countries. Complete vital registra-tion systems are the preferred source of data onchild mortality because they collect informationas events occur and they cover the entire popula-tion. However, many developing countries lackfully functioning vital registration systems thataccurately record all births and deaths. There-fore, household surveys, such as the UNICEF-supported Multiple Indicator Cluster Surveys andthe US Agency for International Development–supported Demographic and Health Surveys, arethe primary sources of data on child mortality indeveloping countries.The IGME seeks to compile all available national-level data on child mortality, including data fromvital registration systems, population censuses,household surveys and sample registration sys-tems. To estimate the under-five mortality trendseries for each country, a statistical model is fittedto data points that meet quality standards estab-lished by the IGME and then used to predict atrend line that is extrapolated to a common ref-erence year, set at 2010 for the estimates in thisreport. To predict infant mortality rates, modellife tables are used to transform under-five mor-tality rates. To predict neonatal mortality rates, a

statistical model is used to transform under-fivemortality rates.

Changes to data sourcesand methodologyThe IGME updates its child mortality estimatesannually after reviewing newly available dataand assessing data quality. In preparing theestimates in this report, the IGME recalculateddirect estimates from all available Demographicand Health Surveys for calendar year periods,using single calendar years for reference peri-ods shortly before the survey and then gradu-ally increasing the number of years for referenceperiods further in the past. For a given surveythe cut-off points for shifting from estimates forsingle calendar years to two years, or two yearsto three and so on are based on the coefficientsof variation (a measure of sampling uncertainty)of the estimates. The Technical Advisory Groupsuggested this recalculation because the sam-ple sizes of many household surveys have grownin recent years, allowing for shorter referenceperiods. The recalculated direct estimates withshorter reference periods replace the five-yearperiods used in previous estimations, therebyincreasing the number of data points for morerecent years.In addition, a substantial amount of newly avail-able data has been incorporated: data fromthe most recent surveys and censuses for about30 countries, new data from vital registrationsystems for more than 50 countries and datafrom more than 70 surveys and censuses con-ducted before 2000 for about 20 countries. Theincreased data availability has resulted in sub-stantial changes in the estimates for some coun-tries from previous years. Because the fittedunder-five mortality rate trend line is based onthe entire time series of data available for eachcountry and because model life tables and a sta-tistical model are used to derive estimates ofinfant and neonatal mortality rates based onunder-five mortality rates, the estimates pre-sented in this report may differ from and not becomparable with previous sets of IGME estimatesand the most recent underlying country data.Furthermore, this year the IGME used a differentcurve-fitting methodology. More details on thedata and methods used in deriving the estimatesare available in the IGME’s child mortality data-base, CME Info (www.childmortality.org).3

Support for data collectionat country levelModelled estimates of child mortality can only beas good as the underlying data. The IGME mem-bers, including UNICEF, the WHO and otherUN agencies, are actively involved at the countrylevel in strengthening national capacity in datacollection, estimation techniques and interpreta-tion of results.Population-based survey data are critical fordeveloping sound estimates for countries lack-ing functioning vital registration systems. TheUNICEF-supported Multiple Indicator ClusterSurveys programme has been working since 1995to build country-level capacity for survey imple-mentation, data analysis and dissemination. Thesurveys are government owned and implemented,and UNICEF provides financial and technicalsupport through workshops, technical consulta-tions and peer-to-peer mentoring. More than230 surveys have been conducted in more than100 countries. In addition to population-basedsurveys, the WHO and the UN Statistics Divi-sion work with countries to strengthen vital reg-istration systems. UNICEF supports this work bypromoting birth registration and monitoring itsprogress. The United Nations Population Fundprovides technical assistance for population cen-suses, another important source of child mortal-ity data.The IGME strengthens capacity by working withcountries to improve understanding of child

mortality data and estimation. CME Info (www.childmortality.org ), a comprehensive data por-tal on child mortality funded by UNICEF andlaunched by the IGME, is a powerful platform forsharing underlying data and collaborating withnational partners on child mortality estimates.Since 2008 a series of regional workshops has beenheld, training more than 250 participants from94 countries in the use of CME Info as well as thedemographic techniques and modelling methodsunderlying the estimates. In the last three yearsUNICEF and the IGME have sent experts to about10 countries to conduct training on child mor-tality estimation. As part of the data review pro-cess, UNICEF’s network of field offices providesopportunities to assess the plausibility of estimatesby engaging in a dialogue about the estimatesand the underlying data. WHO also engages itsMember States in a country consultation processthrough which governments provide feedback onthe estimates and their underlying data.Guiding this capacity strengthening work is afundamental principle: child mortality estima-tion is not simply an academic exercise but afundamental part of effective policies and pro-gramming. UNICEF works with countries toensure that child mortality estimates are usedeffectively at the country level, in conjunctionwith other data on child health, to improvechild survival programmes and stimulate actionthrough advocacy. This work involves partneringwith other agencies, organizations, and initiativessuch as the Countdown to 2015.

Levels and Trends inChildMortality, 1990–2010Under-five mortalityThe latest estimates of under-five mortality fromthe UN Inter-agency Group for Child Mortalityestimation (IGME) show a 35 percent decline inthe under-five mortality rate globally, from 88deaths per 1,000 live births in 1990 to 57 in 2010(table 1 and figure 1). Over the same period, thetotal number of under-five deaths in the worldhas declined from more than 12 million in 1990to 7.6 million in 2010 (table 2).Five of nine developing regions show reductionsin under-five mortality of more than 50 per-cent over 1990–2010 (figure 2). Northern Africahas achieved MDG 4, with a 67 percent reduc-tion, and Eastern Asia is close, with a 63 percentreduction.Sub-Saharan Africa and Oceania have achievedonly around a 30 percent reduction in under-fivemortality, less than half that required to reachMDG 4. However, Sub-Saharan Africa—also com-bating the HIV/AIDS pandemic that has affectedcountries in the region more than elsewhere inthe world—has doubled its average rate of reduc-tion from 1.2 percent a year over 1990–2000 to2.4 percent a year over 2000–2010.A major reason for the limited progress in reduc-ing child mortality at the global level, despitemore than half the regions having alreadyachieved reductions of more than 50 percent, isthe large and growing share of under-five deathsthat occur in Sub-Saharan Africa and SouthernAsia (82 percent; figures 3 and 4). Of the 26 coun-tries with under-five mortality rates above 100deaths per 1,000 live births in 2010, 24 are in Sub-Saharan Africa (map 1). Thus, to achieve MDG 4,substantial progress is needed in both regions.Fourteen of sixty-six countries with at least 40under-five deaths per 1,000 live births in 2010reduced their under-five mortality rate by at leasthalf between 1990 and 2010 (figure5). Timor-Leste, Bangladesh, Nepal, the Lao People’sDemocratic Republic, Madagascar and Bhutanrecorded declines of at least 60 percent, or morethan 4.5 percent a year on average. In absoluteterms the greatest reductions were in Niger,Malawi, Liberia, Timor-Leste and Sierra Leone(surpassing 100 deaths per 1,000 live births dur-ing the period). That 9 of the 14 countries arefrom Sub-Saharan Africa and Southern Asia, thetwo regions most in need of a faster reduction ofthe under-five mortality rate, shows that substan-tial progress can be made in these regions.Among developed regions under-five mortalityrates exceeded 10 deaths per 1,000 live births in2010 in the Republic of Moldova, Albania, Roma-nia, Ukraine, Bulgaria, Russian Federation andThe former Yugoslav Republic of Macedonia.Some 70 percent of the world’s under-five deathsin 2010 occurred in only 15 countries, and abouthalf in only five countries: India, Nigeria, Demo-cratic Republic of the Congo, Pakistan and China(figure 6). India (22 percent) and Nigeria (11percent) together account for a third of under-five deaths worldwide.Overall, substantial progress has been madetowards achieving MDG 4. About 12,000 fewerchildren died every day in 2010 than in 1990, thebaseline year for measuring progress. Improve-ment in child survival is evident in all regions.The number of countries with under-five mor-tality rates of 100 deaths per 1,000 live births orhigher has been halved from 52 in 1990 to 26 in2010. In addition, no country had an under-fivemortality rate above 200 deaths per 1,000 livebirths in 2010, compared with 13 countries in1990. The rate of decline has accelerated from1.9 percent a year over 1990–2000 to 2.5 percenta year over 2000–2010. Moreover, in Sub-SaharanAfrica, the region with the greatest burden ofunder-five deaths, the rate of decline doubled.But these rates are still insufficient to achieveMDG 4 by 2015: only 6 of 10 regions are on trackto achieve the MDG 4.5

TAblE

levels and trends in the under-five mortality rate, by Millennium Development Goal region,1990–2010 (deaths per 1,000 live births)Averageannual rateof reduction(percent)1990–2010Progress towardsMillenniumDevelopment Goal4target2010

Region

1990

1995

2000

2005

2009

2010

MDGtarget2015

Decline(percent)1990–2010

Developed regionsDeveloping regionsNorthern AfricaSub-Saharan AfricaLatin America and the CaribbeanCaucasus and Central AsiaEastern AsiaExcluding ChinaSouthern AsiaExcluding IndiaSouth-eastern AsiaWestern AsiaOceaniaWorld

1597821745477482811712371677588

1190621684471423610210758576882

10804715435623330879148456373

8713513827532519758039385765

7642812422471918677334335358

7632712123451817667232325257

53227581826169394124222529

5335673057426339444155523135

3.82.25.61.84.32.74.92.52.92.74.03.71.82.2

On trackInsufficient progressOn trackInsufficient progressOn trackInsufficient progressOn trackOn trackInsufficient progressInsufficient progressOn trackOn trackInsufficient progressInsufficient progress

a“On track” indicates that under-five mortality is less than 40 deaths per 1,000 live births in 2010 or that the average annual rate of reduction is at least 4 percent over1990–2010; “insufficient progress” indicates that under-five mortality is at least 40 deaths per 1,000 live births in 2010 and that the average annual rate of reduction is atleast 1 percent but less than 4 percent over 1990–2010. These standards may differ from those in other publications by Inter-agency Group for Child Mortality Estimationmembers.

TAblE

levels and trends in the number of deaths of children under age five, by MillenniumDevelopment Goal region, 1990–2010 (thousands)Share of globalunder-five deaths(percent)2010

Region

1990

1995

2000

2005

2009

2010

Decline(percent)1990–2010

22711,7823043,7346231551,308294,5211,4438532701412,010

15110,5502103,977511119845463,9301,2336962471510,702

1299,4461534,00639786704303,3541,060530201159,575

1128,3551213,95630580423162,829875453173148,467

1027,6541003,75223779349172,588837368167147,756

997,515953,70924978331172,526830349165147,614

56366916050754144425939037

1.398.71.248.73.31.04.30.233.210.94.62.20.2100.0

FiGuRE

under-five mortality declined in allregions between 1990 and 2010

FiGuRE

Under-ﬁve mortality rate, by Millennium Development Goal region,1990 and 2010 (deaths per 1,000 live births)200174

Many regions have reduced theunder-five mortality rate by at least50percent between 1990 and 2010

Decline in under-ﬁve mortality rate, by Millennium Development Goal region,1990–2010 (percent)75676357121

150117

5097828842

100757771

5331

25323227231815

Sub-Saharan Africa

South-eastern Asia

Western Asia

Northern Africa

Southern Asia

Oceania

Caucasus andCentral Asia

Latin America andthe Caribbean

Eastern Asia

Developed regions

Developing regions

World

Northern Africa

South-eastern Asia

Western Asia

Sub-Saharan Africa

Eastern Asia

Latin America andthe Caribbean

Southern Asia

Caucasus andCentral Asia

Developing regions

1990

2010

FiGuRE

in 2010, 7.6 million children diedbefore their fifth birthday

FiGuRE

The global burden of under-five deaths isincreasingly concentrated in Sub-Saharan Africa

Number of under-ﬁve deaths, by Millennium Development Goal region,2010 (thousands)Developed regions99Western Asia165Latin America and theCaribbean249Eastern Asia331South-easternAsia349

Northern Africa95Caucasus and Central Asia78Oceania14

Share of under-ﬁve deaths, by Millennium Development Goal region,1990–2010 (percent)Developed regionsNorthern AfricaWestern AsiaCaucasus and Central AsiaOceania100Latin America and the CaribbeanEastern Asia80South-eastern Asia

60Southern AsiaSub-SaharanAfrica3,709SouthernAsia2,52620Sub-Saharan Africa

1990

1995

2000

2005

Developed regions

Oceania

World2010

MAP

Children in Southern Asia and Sub-Saharan Africa face ahigher risk of dying before their fifth birthday

Under-ﬁve mortality rate (deaths per 1,000 live births)Less than 4040–99100–149150 or moreData not available

Note: Data for Sudan refer to the country as it was constituted in 2010, before South Sudan seceded on 9 July 2011.

FiGuRE

Of the 66 countries with high under-fivemortality, 14 have seen reductions of atleast 50 percent between 1990 and 2010

FiGuRE

Half of under-five deaths occurin just five countries

Number of under-ﬁve deaths, by country, 2010 (thousands)

Decline in under-ﬁve mortality rate, 1990–2010 (percent)75676665

India1,696555554

Othercountries2,958Nigeria861

25Dem. Rep. ofthe Congo465Pakistan423China315Ethiopia271

Uganda141Sudana143Timor-LesteBangladeshBhutanCambodiaEritreaBoliviaLiberiaUnited Republicof TanzaniaLao People’sDemocratic RepublicMadagascarAzerbaijanNepalMalawiNiger0Indonesia151Afghanistan191

a. Data refer to Sudan as it was constituted in 2010, before South Sudanseceded on 9 July 2011.

As under-five mortality rates have fallen moresharply in richer developing regions, the dispar-ity between Sub-Saharan Africa and other regionshas grown. In 1990 a child born in Sub-SaharanAfrica faced a probability of dying before age 5that was 1.5 times higher than in Southern Asia,3.2 times higher than in Latin America and theCaribbean, 3.6 times higher than in Eastern Asiaand 11.6 times higher than in developed regions.By 2010 that probability was 1.8 times higher thanin Southern Asia, 5.3 times higher than in LatinAmerica and the Caribbean, 6.7 times higherthan in Eastern Asia and 17.3 times higher thanin developed regions. The disparity betweenSouthern Asia and richer regions has also grown,though not as much.Of the 66 countries with at least 40 deaths per1,000 live births in 2010, only 11 are on track toachieve MDG 4 (map 2). But substantial advanceshave been made, particularly in Sub-SaharanAfrica. Six of the fourteen best-performing coun-tries are in Sub-Saharan Africa (see figure 5),as are four of the five countries with the largestabsolute reductions in under-five mortality.Thus, there is increasing evidence that MDG 4 canbe achieved, but only if countries in Sub-SaharanMAP

Africa and Southern Asia give high priority toreducing child mortality, particularly by targetingthe major killers of children (including pneumo-nia, diarrhoea, malaria and undernutrition) witheffective preventative and curative interventions.Neonatal mortality

Neonatal mortality, covering deaths in the firstmonth after birth, is of interest because thehealth interventions needed to address the majorcauses of neonatal deaths generally differ fromthose needed to address other under-five deaths.Neonatal mortality is increasingly importantbecause the proportion of under-five deaths thatoccur during the neonatal period is increasing asunder-five mortality declines.Over the last two decades almost all regions haveseen slower declines in neonatal mortality thanin under-five mortality. Globally, neonatal mor-tality has declined 28 percent from 32 deaths per1,000 live births in 1990 to 23 in 2010—an aver-age of 1.7 percent a year, much slower than forunder-five mortality (2.2 percent per year) andfor maternal mortality (2.3 percent per year).The fastest reduction was in Northern Africa(55 percent), followed by Eastern Asia and LatinAmerica and the Caribbean (52 percent); the

Many countries were on track in 2010 to achieve Millennium Development Goal 4, but progressneeds to accelerate in several regions, particularly in Southern Asia and Sub-Saharan Africa

On track: under-ﬁve mortality is less than 40 deaths per 1,000 livebirths in 2010 or the average annual rate of reduction of under-ﬁve mortalityis at least 4 percent over 1990–2010.Insufﬁcient progress: under-ﬁve mortality is at least 40 deaths per1,000 live births in 2010 and the average annual rate of reduction is at least1 percent but less than 4 percent over 1990–2010.

No progress: under-ﬁve mortality is at least 40 deaths per1,000 live births in 2010 and the average annual rate of reduction isless than 1 percent over 1990–2010.Data not available.

Note: These standards may differ from those in other publications by Inter-agency Group for Child Mortality Estimation members. Data for Sudanrefer to the country as it was constituted in 2010, before South Sudan seceded on 9 July 2011.

slowest reduction was in Oceania and Sub-Saha-ran Africa (19 percent; table 3).Over the same period the share of neonataldeaths among under-five deaths has increasedfrom about 37 percent to slightly above 40percent worldwide and is expected to furtherincrease as under-five mortality declines. Whilethe relative increase is modest (9 percent) atthe global level, there are differences acrossregions. The largest increases have been inNorthern Africa (37 percent) and Eastern Asia(27 percent), the smallest in Oceania (7 per-cent; see table 3). In Eastern Asia, which hadone of the largest declines in under-five mortal-ity, neonatal deaths accounted for 57 percent ofunder-five deaths in 2010. Eastern Asia, North-ern Africa and other richer developing regionswill have to pay more attention to health inter-ventions that address neonatal mortality inorder to continue their success in reducingunder-five mortality.Southern Asia also needs to address neonatalmortality: neonatal deaths account for 50 per-cent of under-five deaths, and almost 30 percentof global neonatal deaths occurred in India.Sub-Saharan Africa, which accounts for morethan a third of global neonatal deaths, has thehighest neonatal mortality rate (35 deaths perTAblE

1,000 live births in 2010) and has shown theleast progress in reducing that rate over the lasttwo decades.With the proportion of under-five deaths duringthe neonatal period increasing in every regionand almost all countries, systematic action isrequired by governments and partners to reachwomen and babies with effective care. Highlycost-effective interventions are feasible even atthe community level, and most can be linkedwith preventive and curative interventions formothers and for babies. For example, early post-natal home visits are effective in promotinghealthy behaviours such as breastfeeding andclean cord care as well as in reaching new moth-ers. Case management of neonatal infectionscan be provided alongside treatment of child-hood pneumonia, diarrhoea and malaria. Careat birth brings a triple return on investment,preventing stillbirths and saving mothers andnewborns.

Disparity in child mortalityDespite substantial progress in reducing under-five deaths, children from rural and poorerhouseholds remain disproportionately affected.Analyses based on data from household surveysfor a subset of countries indicate that childrenin rural areas are about 1.7 times as likely to die

neonatal mortality rate, number of neonatal deaths and neonatal deaths as a share ofunder-fivedeaths, by Millennium Development Goal region, 1990 and 2010Neonatal mortality rate(deaths per 1,000 live births)Decline(percent)1990–2010Number of neonatal deaths Neonatal deaths as a share of under-five deaths(thousands)(percent)Relativeincrease(percent)1990–2010

Region

1990

2010

1990

2010

1990

2010

736294323302312484828282632

42513351121119323315162123

4331551952305225333146431928

1064,31910796926558589141,87557633511654,425

533,019461,1231173418981,2563811697953,072

4737352642374547414039433737

5340493047445748504648484040

1510371711182712015231279

before their fifth birthday as those in urban areasand that children from the poorest 20 percent ofhouseholds are nearly twice as likely to die beforetheir fifth birthday as children in the richest 20percent of households (figure 7).Similarly, mother’s education remains a pow-erful determinant of inequity. Children ofeducated mothers—even mothers with onlyprimary education—are more likely to survivethan children of mothers with no education(see figure 7).Accelerating the decline in under-five mor-tality is possible by expanding interventionsthat target the main causes of deaths and themost vulnerable newborn babies and children.Empowering women, removing financial andsocial barriers to accessing basic services, devel-oping innovations that make the supply of criti-cal services more available to the poor andincreasing local accountability of health systemsare examples of policy interventions that haveallowed health systems to improve equity andreduce mortality. An equity-focused approachcould bring vastly improved returns on invest-ment by averting far more child deaths andepisodes of undernutrition and by markedlyexpanding effective coverage of key primaryhealth and nutrition interventions.

FiGuRE

Children who live in poorer householdsand rural areas and whose mothers have lesseducation are at higher risk of dying before age 5

Under-ﬁve mortality rate, by wealth quintile, residence and mother’seducation, 2000–2010 (deaths per 1,000 live births)15014612111410111490626791

120

Poorest

Second

Fourth

Richest

Middle

Urban

Rural

Primary

Wealth

Residence

Mother’s education

Note: Calculation is based on 39 countries with most recentDemographic and Health Surveys conducted after 2005, with furtheranalyses by UNICEF for under-ﬁve mortality rates by wealth quintile, 45countries for rates by residence and 40 countries for rates by mother’seducation. The average was calculated based on under-ﬁve mortality ratesweighted by number of births. Country-speciﬁc estimates obtained fromDemographic and Health Surveys refer to a 10-year period prior to thesurvey. Because levels or trends may have changed since then, cautionshould be used in interpreting these results.

Secondaryor higher

None

StatiStical table

country, regional and global estimates ofunder-five, infant and neonatal mortalityNumber ofunder-fivedeaths(thousands)Infantmortality rate(deaths per1,000 live births)Number ofinfantdeaths(thousands)Neonatalmortality rate(deaths per 1,000live births)Number ofneonataldeaths(thousands)

Under-fivemortality rate(deaths per 1,000 live births)MillenniumDevelopment Average annualGoalrate of reductiontargetfor(percent)201020151990–20101491836416181420544616104820641711556548481971317614251136636159173918198693910123667014233819918333176486631559464062020476861404632055696161242397650441.74.13.24.12.15.93.35.12.94.13.51.62.75.5–0.55.24.64.82.24.54.04.31.05.72.72.60.81.34.30.01.42.50.20.93.74.93.31.91.14.02.71.03.93.9

Country or territoryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCook IslandsCosta RicaCôte d'IvoireCroatiaCuba

1990209416892432627559993221714318171044178139121195959122220518312113785916520719483712511620171511313

19901283530123020421190052703103732813210038545386631195561,27933210017613

20101911260121010110900140011039114025501120381693202380231518213018001

1990140365571442324468874181599161493510796841746509181031108785746110113163830887417151051111

2010103163139871218443914938174414734442836176119388438452910699816176361898655

199087343074018421150036302102322012174024327244231133051,0252717015312

2010133122072091108001090000251100248016424145820164622721528015600

199053172935113152654319655974184045391222287114149383442143459242040339104687

201045918141471132197427103283226235191247384222344144241511123229564133

19904012302801121060020801109191110201181216172051335761913012401

20106201303305110400830000110601360027127241072011811114002700

StatiStical table(ContInuED)

Under-fivemortality rate(deaths per 1,000 live births)MillenniumDevelopment Average annualGoalrate of reductiontargetfor(percent)201020151990–20104433170491122720221612161510617347498224744113213015030165—2462633526394542445156034162117312163477611023315516341472676702250—196238282215343135.16.31.60.34.11.51.74.24.87.36.82.34.27.22.82.84.24.11.12.63.84.12.55.93.24.52.81.73.9–0.4—4.45.85.53.04.44.60.84.14.44.62.3

Country or territoryCyprusCzech RepublicDemocratic People'sRepublic of KoreaDemocratic Republicof the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsraelItalyJamaica

1990111445181912317625294621901412118430799316547912213217822921066151—581961158565469121038

1990021631213013151741031813981063747681026589138—11303,078403122300152

201000124650206641231102710033613571014488045—5101,69615134430121

199010122311779514484168481188717111256768784077711175613512550104—4517581565037810831

20103326112373112218191481424681523545720350392581922570—20524827223134320

19900272060201012126821202450052346431019355126—8202,18526192240152

2010009306020553522801710032412380011315019—4101,30511529350121

199059224844011292028184531134812433142274389102851483438—231234731282356613

201022184623481510963518335822263115228251538401927—1241321714202229

199001989010665031401120031223221010142110—4201,29914951160131

2010006132010331811309200212122200715207—2008757318230010

StatiStical table(ContInuED)

Under-fivemortality rate(deaths per 1,000 live births)MillenniumDevelopment Average annualGoalrate of reductiontargetfor(percent)201020151990–20103223385491138541022851031727362926151786261111517424328361356640405046271431432232131933295244871330761536353746348541741816193366297337241347342310471533.52.72.70.82.91.63.24.93.72.70.24.04.98.04.44.94.74.45.59.61.83.03.40.62.45.31.44.16.04.14.42.42.63.00.05.23.53.04.63.92.0–2.35.5

Country or territoryJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's DemocraticRepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia (FederatedStates of)MonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNiueNorway

19906385799871572145213889227451017815922218102255115112424495691071886219112734014181168311213149

1990852397011024135215010789291102001011150080611231204099211012487200

201034131220158025152000445630120001303700202311456203510410086100

199053248646413591001631721513391479713115741311040802138447761667146794932977952132126127

201021829553910334281965741325243585149952275131434326730925029324145237388193

19905419630181712414301050558152006191006046818530691175351600

2010331180015601411200031363068009031002020774320291035253700

1990320263129930391218365322—10440449375771942161722527113651442522545425484974

201011317281961921512353410—3122273948412399718212519393217222833123240102

1990331030004701252—1020195024003041002026314710401042121100

201012643002301251—0016182034005016001012352610201022425400

StatiStical table(ContInuED)

Under-fivemortality rate(deaths per 1,000 live births)MillenniumDevelopment Average annualGoalrate of reductiontargetfor(percent)201020151990–201022987192061251929648519141291816212028018757141743832718057517103317835166313151641111130172620657312129549899431154610692363156020411421732231339113.68.31.82.82.51.93.57.13.65.26.64.82.43.34.94.12.96.31.81.31.59.00.84.63.17.11.02.34.94.16.02.60.00.33.93.21.02.61.04.22.44.33.14.5

Country or territoryOccupied Palestinian TerritoryOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRepublic of KoreaRepublic of MoldovaRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanaSurinameSwazilandSwedenSwitzerlandSyrian Arab RepublicTajikistanThailand

199045471243333905078591715218373727163282327129445139291727681810451806011321255296783811632

19904355102127501209204315605200000025424045010152644111260411172535

2010314230112411663003132038000000123410390000705826143030081211

1990363696272665405542151117630292299221821231161367025141626159361084792678447067319126

2010208701517472115235374161195971419172531550612114272231084141466275524145211

1990334310295368581043124832000000192130260100335049800310142029

2010303470110395220021316250000001023102600004241259202007109

1990—22511414302427231171031515124117131610528204016957412518521861839212434183717

2010—54199231491442429862951013812510274845142125218310351421239258

1990—22300143184661021525120000001213201001001520364301008818

2010—01940152632100102101300000061300100000211914500100457

Saint Vincent and the Grenadines27

StatiStical table(ContInuED)

Under-fivemortality rate(deaths per 1,000 live births)MillenniumDevelopment Average annualGoalrate of reductiontargetfor(percent)201020151990–201012551031627161856339913757681152141823771118013564981216273319587735248261311174361265.95.61.82.21.65.67.52.82.72.82.45.72.93.61.63.72.05.13.04.02.52.5–0.1

Country or territoryThe former YugoslavRepublic of MacedoniaTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited Republic of TanzaniaUnited StatesUruguayUzbekistanVanuatuVenezuela (BolivarianRepublic of)Viet NamYemenZambiaZimbabwe

1990391691472537498098571752122915511237739335112818378

19901422011110713014315171664415601999756029

2010021901324601417141333213101134696029

199034127872132396678441061818895920633128379010952

2010104666132414144727631165507944121619576951

19901313019871108813161033714601670523619

2010021200319509261490280270928523819

19901748401123233333223691254061130161723434027

20108243281891023142664326462371012323027

199012601547403161445221220945271410

201001600213203930248180130618291810

Estimates of under-five, infant and neonatal mortality by Millennium Development Goal regionb,cDeveloped regionsDeveloping regionsNorthern AfricaSub-Saharan AfricaLatin America & CaribbeanCaucasus & Central AsiaEastern AsiaExcluding ChinaSouthern AsiaExcluding IndiaSouth-eastern AsiaWestern AsiaOceaniaWorld15978217454774828117123716775887632712123451817667232325257532275818261693941242225293.82.25.61.84.32.74.92.52.92.74.03.71.82.222711,7823043,7346231551,308294,5211,4438532701412,010997,515953,70924978331172,526830349165147,614126762105436338178490495255616442376183916145156252541401868,2022272,2734911271,042173,2391,053582211118,389835,346812,35019167285141,958653271131115,429736294323302312484828282632425133511211193233151621231064,31910796926558589141,87557633511654,425533,019461,1231173418981,2563811697953,072

StatiStical table(ContInuED)

country, regional and global estimates ofunder-five, infant and neonatal mortalityEstimates of under-five, infant and neonatal mortality by uniCEF regioncUnder-fivemortality rate(deaths per 1,000 live births)MillenniumAverageDevelopment annual rate ofGoalreductiontargetfor(percent)20151990–20105358526526294018181.81.82.31.63.22.92.94.14.3Number ofunder-fivedeaths(thousands)Infantmortality rate(deaths per1,000 livebirths)Number ofinfantdeaths(thousands)Neonatalmortality rateNumber of(deaths per 1,000 neonatal deathslive births)(thousands)

RegionAfricaSub-Saharan AfricaEastern and Southern AfricaWest and Central AfricaMiddle East and North AfricaAsiaSouth AsiaEast Asia and PacificLatin America and CaribbeanCentral and EasternEurope/Commonwealth ofIndependent StatesIndustrialized countriesDeveloping countriesLeast developed countriesWorld

199016017415619677861205554

2010111121981434148672423

19904,0383,7341,5592,0467186,5754,3992,175623

20103,8043,7091,3222,2414153,1862,492694249

199099105971155662864143

2010717663883137521918

19902,5002,2739821,2085264,7813,1471,634491

20102,4312,3508581,3983162,4961,929567191

1990414339472937492523

2010333530391824331311

19901,0769694115142712,7541,824930265

20101,1691,1234256471801,6021,239363117

50109717088

2366311057

173325729

3.92.62.22.22.2

37111811,7843,49712,010

136657,5162,9497,614

4196710661

195447140

303978,2042,2008,389

114555,3461,9125,429

215364732

113253423

149614,3201,0244,425

65363,0199563,072

Estimates of under-five, infant and neonatal mortality by World Health Organization regioncUnder-fivemortality rate(deaths per 1,000 live births)MillenniumAverageDevelopment annual rate ofGoalreductiontargetfor(percent)20151990–2010571433113716291.84.21.94.33.44.62.2Number ofunder-fivedeaths(thousands)Infantmortality rate(deaths per1,000 livebirths)Number ofinfantdeaths(thousands)Neonatalmortality rateNumber of(deaths per 1,000 neonatal deathslive births)(thousands)

RegionAfricaAmericasEastern MediterraneanEuropeSouth-East AsiaWestern PacificWorld

199017242100331114888

2010119186814561957

19903,6066701,3924314,2991,60712,010

20103,5202841,0701612,1104677,614

1990104347427783761

201075145112441640

19902,2005301,0313533,0131,2578,389

20102,2362218141351,6273935,429

199042183814452232

2010349287291123

19909332895331811,7807094,425

20101,064137444791,0962523,072

StatiStical table(ContInuED)

country, regional and global estimates ofunder-five, infant and neonatal mortalityEstimates of under-five, infant and neonatal mortality by World bank regioncUnder-fivemortality rate(deaths per 1,000 live births)MillenniumAverageDevelopment annual rate ofGoalreductiontargetfor(percent)20151990–201055283816321916182540584292.12.42.54.52.24.23.84.34.02.91.83.52.2Number ofunder-fivedeaths(thousands)Infantmortality rate(deaths per1,000 livebirths)Number ofinfantdeaths(thousands)Neonatalmortality rateNumber of(deaths per 1,000 neonatal deathslive births)(thousands)

RegionLow incomeMiddle incomeLower middle incomeUpper middle incomeLow and middle incomeEast Asia & PacificEurope & Central AsiaLatin America & CaribbeanMiddle East & North AfricaSouth AsiaSub-Saharan AfricaHigh incomeWorld

1990164831134996564954741201741288

2010107516920622423233367121657

19903,1948,6566,3272,33011,8502,1713736225574,3993,72815512,010

20102,6674,8604,1636987,5276911362492552,4923,704857,614

19901035978396742414356861051061

20107038501644201918275276540

19902,0156,2444,3791,8658,2591,6303044904183,1472,2691278,389

20101,7313,6233,0365885,3555651141912101,9292,346725,429

19904633412335252123294943632

20103323291125131111163335423

19909443,4022,3741,0284,3469271492642141,824967794,425

20108662,1611,7873743,027362651171231,2391,121453,072

Estimates of under-five, infant and neonatal mortality by united nations Population Division regionCUnder-fivemortality rate(deaths per 1,000 live births)MillenniumAverageDevelopment annual rate ofGoalreductiontargetfor(percent)20151990–2010532572737585328618412293.82.22.22.62.31.81.83.04.74.32.31.72.2Number ofunder-fivedeaths(thousands)Infantmortality rate(deaths per1,000 livebirths)Number ofinfantdeaths(thousands)Neonatalmortality rateNumber of(deaths per 1,000 neonatal deathslive births)(thousands)

RegionMore developed regionsLess developed regionsLeast developed countriesExcluding least developedcountriesExcluding ChinaSub-Saharan AfricaAfricaAsiaEuropeLatin America & CaribbeanNorthern AmericaOceaniaWorld

1990159717082110174160831854113588

201076311049701211114672372557

199022611,7843,4968,28710,5043,7344,0387,116168623471712,010

2010997,5162,9494,5677,2013,7093,8043,4535924935167,614

1990126710659751059960154392661

201064471374976713661861940

19901858,2042,1996,0057,1792,2732,5005,20713849139138,389

2010835,3461,9123,4355,0752,3502,4312,7164919130125,429

199073647333943413582361332

201042534222735332341141023

19901054,3201,0243,2963,7449691,0762,977762652474,425

2010533,0199562,0632,8381,1231,1691,729311172063,072

— not available.Note: The data on population used to calculate the number of under-five and infant deaths and the data on live births used to calculate neonatal deaths are fromWorld Population Prospects: The 2010 Revision,published by the United Nations Department of Economic and Social Affairs.aData refer to Sudan as it was constituted in 2010, before South Sudan seceded on 9 July 2011.bSee next page for country classifications by region.cThe sum of the number of deaths by region may differ from the world total because of rounding.

RegionalClassificationsThe regional classifications that are referred to in the report and for which aggregate data are provided inthe statistical table are Millennium Development Goal regions (see below). Aggregates presented for memberorganizations of the Inter-agency Group for Child Mortality Estimation may differ. Regions with the same namesin different agencies may include different countries.

Developed regionsAlbania, Andorra, Australia, Austria, Belarus, Bel-gium, Bosnia and Herzegovina, Bulgaria, Canada,Croatia, Cyprus, Czech Republic, Denmark, Estonia,Finland, France, Germany, Greece, Hungary, Iceland,Ireland, Israel, Italy, Japan, Latvia, Liechtenstein,Lithuania, Luxembourg, Malta, Monaco, Montenegro,Netherlands, New Zealand, Norway, Poland, Portugal,Republic of Moldova, Romania, Russian Federation,San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden,Switzerland, The former Yugoslav Republic of Mace-donia, Ukraine, United Kingdom, United States

Oceania

Cook Islands, Fiji, Kiribati, Marshall Islands,Micronesia (Federated States of), Nauru, Niue, Palau,Papua New Guinea, Samoa, Solomon Islands, Tonga,Tuvalu, VanuatuSouth-eastern Asia

Brunei Darussalam, Cambodia, Indonesia, LaoPeople’s Democratic Republic, Malaysia, Myanmar,Philippines, Singapore, Thailand, Timor-Leste,VietNamSouthern Asia

Developing regionsCaucasus and Central Asia

Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyz-stan, Tajikistan, Turkmenistan, UzbekistanEastern Asia

Afghanistan, Bangladesh, Bhutan, India, Iran(Islamic Republic of), Maldives, Nepal, Pakistan,SriLankaSub-Saharan Africa

China, Democratic People’s Republic of Korea,Mongolia, Republic of Korealatin America and the Caribbean

Antigua and Barbuda, Argentina, Bahamas, Barba-dos, Belize, Bolivia (Plurinational State of), Brazil,Chile, Colombia, Costa Rica, Cuba, Dominica, Domin-ican Republic, Ecuador, El Salvador, Grenada, Gua-temala, Guyana, Haiti, Honduras, Jamaica, Mexico,Nicaragua, Panama, Paraguay, Peru, Saint Kitts andNevis, Saint Lucia, Saint Vincent and the Grenadines,Suriname, Trinidad and Tobago, Uruguay, Venezuela(Bolivarian Republic of)northern Africa

Angola, Benin, Botswana, Burkina Faso, Burundi,Cameroon, Cape Verde, Central African Republic,Chad, Comoros, Congo, Côte d’Ivoire, DemocraticRepublic of the Congo, Djibouti, EquatorialGuinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana,Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia,Madagascar, Malawi, Mali, Mauritania, Mauritius,Mozambique, Namibia, Niger, Nigeria, Rwanda,Sao Tome and Principe, Senegal, Seychelles, SierraLeone, Somalia, South Africa, Sudan*, Swaziland,Togo, Uganda, United Republic of Tanzania,Zambia, ZimbabweWestern Asia

Algeria, Egypt, Libyan Arab Jamahiriya, Morocco,Tunisia

Bahrain, Iraq, Jordan, Kuwait, Lebanon, OccupiedPalestinian Territory, Oman, Qatar, Saudi Arabia,Syrian Arab Republic, Turkey, United Arab Emirates,Yemen

* Data refer to Sudan as it was constituted in 2010, before South Sudan seceded on 9 July 2011.

On the cover photo: A malnourished child waits for a meal of rice and dal at an anganwadi centre in SullineabadVillage, Bihar State, India. Anganwadis are part of the national Integrated Child Development Services programme,which provides basic health education, nutrition and related services at the village level for children and womenin impoverished areas. Some 29 percent of children in the village suffer from severe acute malnutrition.Photo credits: cover, � UNICEF/NYHQ2009‑0908/Brian Sokol; page 2, � UNICEF/NYHQ2011‑1115/KateHolt;page 4, � UNICEF/INDA2011‑00039/Graham Crouch; page 20, � UNICEF/INDA2010‑00212/Graham Crouch.

The Inter-agency Group for Child Mortality Estimation (IGME) was formed

in 2004 to share data on child mortality, harmonize estimates within

the UN system, improve methods for child mortality estimation, report

on progress towards the Millennium Development Goals and enhance

country capacity to produce timely and properly assessed estimates of

child mortality. The IGME, led by the United Nations Children’s Fund and

the World Health Organization, also includes the World Bank and the

United Nations Population Division of the Department of Economic and

Social Affairs as full members.

The IGME’s independent Technical Advisory Group, comprising eminent

scholars and independent experts in demography, provides technical

guidance on estimation methods, technical issues and strategies for data

analysis and data quality assessment.

The IGME updates its child mortality estimates annually after reviewing

newly available data and assessing data quality. This report contains

the latest IGME estimates of child mortality at the country, regional and

global levels. Country-specific estimates and the data used to derive them

are available at www.childmortality.org.