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Executive Summary
Committing to Child Survival: A Promise
Renewed
2014 Progress Report
The promise: In 2000, the world made a promise to children: to reduce by two-thirds between 1990
and 2015, the rate of under-five mortality. In 2012, world leaders renewed the promise. Since the
global launch of
Committing to Child Survival: A Promise Renewed
in June 2012, nearly 180
governments have pledged to scale up efforts to accelerate declines in preventable maternal,
newborn and child deaths.
An overview of child survival: good news and bad
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Globally, major progress has been made in improving child survival. The under-five mortality
rate has declined by almost half since 1990,
dropping from 90 to 46 deaths per 1,000 live births
in 2013. The absolute number of under-five deaths was cut in half during the same period, from
12.7 million to 6.3 million, saving 17,000 lives every day.
The under-five mortality is falling faster than at any other time during the past two decades.
Globally, the annual rate of reduction has more than tripled since the early 1990s. Eastern and
Southern Africa currently has highest annual rate of reduction in the world with the exception of
East Asia and the Pacific. Thanks to this accelerated progress, almost 100 million children have
been saved over the past two decades – including 24 million newborns. These are babies who
would have died had mortality remained at 1990 rates.
Under-five mortality is falling among the poorest children in all regions.
Moreover, greater
gains have been made among the poorest households than among the richest in all regions
except sub-Saharan Africa. Between 1990 and 2010, the gap between the richest and poorest
households fell in all regions except sub-Saharan Africa. However, substantial disparities remain
in all regions.
But despite these advances, the toll of under-five deaths over the past two decades is
staggering:
between 1990 and 2013, 223 million children worldwide died before their fifth
birthday.
Progress is insufficient to meet MDG 4.
If current trends continue in all countries, the target
will only be reached globally by 2026, 11 years behind schedule.
Sub-Saharan Africa and South Asia, together account for 4 out of 5 under-five deaths globally.
Sub-Saharan Africa continues to shoulder the greatest burden: 1 in 11 children born there still
die before age 5, nearly 15 times the average in high-income countries (1 in 159). The recent
momentum achieved in Sub-Saharan Africa needs to be sustained and accelerated.
Although child deaths from leading infectious diseases have declined significantly, pneumonia,
diarrhoea and malaria are still the main killers of children.
Pneumonia, diarrhoea or malaria
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make up about one third of all under five deaths in 2013.
Importantly, neonatal deaths account
for 44% of all under-five deaths.
The first month of life: the most vulnerable period
The first 28 days of life – the neonatal period – is the most vulnerable time for a child’s
survival. The good news is that neonatal mortality is declining globally.
The worldwide
neonatal mortality rate fell by 40 per cent between 1990 and 2013
from 33 to 20 deaths per
1,000 live births.
The lives of 24 million newborns have been saved since 1990.
Yet despite the availability of
effective, proven strategies to prevent newborn deaths,
2.8 million babies still died in the first
month of life
in 2013, largely of preventable causes. Neonatal health must be prioritized to
sustain the rapid progress on overall child mortality.
Mortality during the neonatal period is falling slower than during other age groups.
As a result,
the proportion of under-five deaths during the neonatal period has gone up in every region.
Globally, it increased from 37 to 44 per cent between 1990 and 2013.
For 1 million babies every year, their day of birth is also their day of death, accounting for
more than a third of neonatal deaths. Close to 2 million newborns die in the first week of life.
Investments in maternal care, specifically labour and delivery care and other high-impact
interventions focused on the 24 hours around the time of birth, hold the greatest potential for
reducing neonatal mortality.
Many deaths in the first month of life result from diseases and conditions that are readily
preventable or treatable with proven, cost-effective interventions.
Globally, preterm birth
complications and complications during labour and delivery (intrapartum-related complications)
account for nearly 60 per cent of neonatal deaths. The focus clearly needs to be on preventing
these deaths by providing high-quality care for both the mother and the baby around the time of
birth.
Educating women is crucial for reducing neonatal mortality.
Neonatal mortality rates among
mothers with no education are nearly twice as high as for mothers with secondary education or
higher. The family’s wealth and geographic location (urban/rural) also remain powerful
determinants of inequities in neonatal mortality.
Some newborns are particularly vulnerable - those born to the youngest and oldest mothers,
as well as mothers living in rural areas. Children born shortly after another sibling are also at
greater risk of dying than those born after longer intervals between births.
Therefore, ending
child marriage, reducing adolescent pregnancy and extending birth intervals are crucial to
reducing the risk of newborn mortality.
The Promise: Reaching every newborn with quality care
Too many mothers and newborns miss out on key interventions that can save their lives.
Pregnant mothers and their babies require access to high-quality services along a continuum of
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care from pregnancy through childbirth and the postnatal period. There is substantial variation
in access to and use of these services and in the quality of care across countries.
Newborns are most vulnerable during the first hours and days of life, yet this critical window
of opportunity is being missed.
o
Evidence shows that initiating breastfeeding within one hour of birth reduces the risk of
neonatal death by 44 per cent. Yet fewer than half of newborn babies (43 per cent)
worldwide receive the benefits of immediate breastfeeding.
o
In the regions with the highest neonatal mortality rates, access to postnatal care is
abysmally low.
In the majority of countries with data in sub-Saharan African and South Asia,
fewer than half of mothers and babies receive a postnatal health check.
Complications during labour and delivery are responsible for approximately a quarter of all
neonatal deaths worldwide.
Yet in 2012, one in three babies
an estimated 44 million
entered the world without the help of a skilled health care provider, putting them at even
greater risk during this most vulnerable time.
Coverage of key maternal and newborn interventions is too low.
o
Only about half of women worldwide receive the recommended minimum of four antenatal
care visits. Global progress has been modest since 1990, increasing on average only by 15
percentage points, from 37 to 52 per cent of women.
o
One third of women globally deliver their baby without the help of a doctor, nurse or
midwife. The global rate of women delivering with skilled attendance has risen by a mere 12
percentage points since 1990– from 57 to 69 per cent.
Quality of care is grossly lacking even for babies and mothers who have contact with the
health system.
o
A 10 countries analysis suggests that
less than 10 per cent
of mothers who saw a skilled
provider during pregnancy received a set of eight key interventions.
o
Similarly,
less than 10 per cent
of babies who were delivered by a skilled health professional
went on to receive seven needed interventions, including early initiation of breastfeeding
and postnatal care.
In the least developed countries, women in the richest households are almost three times as
likely to give birth with a skilled attendant as women in the poorest. The poorest are worst off
in the countries with the lowest coverage.
Not only are poor mothers and babies less likely to
have contact with the health system, but when they do they are less likely to receive high-quality
care.
Globally, only 59 per cent of children under age 1 have had their birth registered at birth. In
the high-mortality regions of South Asia and sub-Saharan Africa, only about one third of
infants are registered.
Children must be registered at birth if they are to have assured access to
services, such as to health care and education.
Better data are needed to help guide programmes.
Although information on use of basic
services increased greatly over the past decade, more effort is needed to understand the quality
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of care available to women across the continuum of pregnancy, delivery and the postnatal
period. Expanding the availability and quality of population and health facility data must include
a concerted effort to register every newborn and count the deaths of every mother and
newborn, including stillbirths.
Global commitment and priorities for action
Since the global launch of
A Promise Renewed
in June 2012,
nearly 180 governments
have
pledged to scale up efforts to accelerate declines in preventable maternal, newborn and
child deaths.
Under the banner of
A Promise Renewed,
nearly 20 of these are turning their pledges into
practical action by sharpening national strategies for reproductive, maternal, newborn and
child health, setting costed targets and monitoring progress. More countries need to do the
same. By scaling-up progress for women and children, governments are positioning
countries to close the gap on MDG 4 and sustain the progress well after 2015.
With millions of women and children still at risk of dying of preventable causes, maternal,
newborn and child survival must remain at the heart of the post-2015 global development
agenda. The world cannot abandon its promise to women and children.
Now is the time to scale-up progress.
The Every Newborn Action Plan
represents a global
consensus on the actions that need to be taken to scale up progress on newborn survival.
The world has the knowledge and solutions to save ever more women, newborns and
children from dying of causes that are easily avoidable.
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