Levels & Trends In Report 2020 Child Mortality UN Inter .
Levels & Trends inChildMortalityReport 2020Estimates developed by theUN Inter-agency Group forChild Mortality EstimationUnitedNations
This report was prepared at UNICEF headquarters by David Sharrow, Lucia Hug, Yang Liu, and Danzhen You on behalf of the UnitedNations Inter-agency Group for Child Mortality Estimation (UN IGME).Organizations and individuals involved in generating country-specific estimates of child mortality(Individual contributors are listed alphabetically.)United Nations Children’s FundLucia Hug, Sinae Lee, Yang Liu, Anupam Mishra, David Sharrow, Danzhen YouWorld Health OrganizationBochen Cao, Jessica Ho, Kathleen Louise StrongWorld Bank GroupEmi SuzukiUnited Nations, Department of Economic and Social Affairs, Population DivisionKirill Andreev, Lina Bassarsky, Victor Gaigbe-Togbe, Patrick Gerland, Danan Gu, Sara Hertog, Nan Li, Thomas Spoorenberg, PhilippUeffing, Mark WheldonUnited Nations Economic Commission for Latin America and the Caribbean, Population DivisionGuiomar Bay, Helena Cruz CastanheiraSpecial thanks to the Technical Advisory Group of the UN IGME for providing technical guidance on methods for child mortalityestimationLeontine Alkema, University of Massachusetts, AmherstRobert Black, Johns Hopkins UniversitySimon Cousens, London School of Hygiene & Tropical MedicineTrevor Croft, The Demographic and Health Surveys (DHS) Program, ICFMichel Guillot, University of Pennsylvania and French Institute forDemographic Studies (INED)Kenneth Hill (Chair), Stanton-Hill ResearchBruno Masquelier, University of LouvainColin Mathers, University of EdinburghJon Pedersen, Mikro!Jon Wakefield, University of WashingtonNeff Walker, Johns Hopkins UniversitySpecial thanks to the United States Agency for International Development (USAID), including William Weiss and Robert Cohen, and theBill & Melinda Gates Foundation, including Kate Somers and Savitha Subramanian, for supporting UNICEF’s child mortality estimationwork. Thanks also go to the Joint United Nations Programme on HIV/AIDS, including Mary Mahy and Juliana Daher, for sharingestimates of AIDS mortality. Thanks also to Rob Dorrington for providing data for South Africa, Jing Liu from Fafo for preparingunderlying data, and Theresa Diaz from WHO.We would also like to extend special thanks to UNICEF and WHO field office colleagues as well as Sebastian Bania, Kassa Beyene, JohnPaul-Joseph and the Platforms and Service delivery O365 team at UNICEF for supporting the country consultations. Special thanks alsoto the many government agencies in countries for providing data and valuable feedback through the country consultation process.Great appreciation also goes to the many UNICEF colleagues who supported this work, including Vidhya Ganesh (Director, Division ofData, Analytics, Planning and Monitoring), Mark Hereward (Associate Director, Data and Analytics Section, Division of Data, Analytics,Planning and Monitoring), Yanhong Zhang, Attila Hancioglu, Karen Avanesyan, Liliana Carvajal, Yadigar Coskun, Gagan Gupta,Karoline Hassfurter, Tedbabe Degefie Hailegebriel, Richard Kumapley, Yves Jaques, Daniele Olivetti, Luwei Pearson, Eva Quintana,Anshana Ranck, Jennifer Requejo, Aleksi Tzatzev, Turgay Unalan, and Upasana Young. Thanks also to Khin Wityee Oo from UNICEF forproofreading.Lisa Hiller and Jen King from Small World Stories edited the report.Jiayan He laid out the report.Copyright 2020by the United Nations Children’s FundISBN: 978-92-806-5147-8The United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) constitutes representatives of the United NationsChildren’s Fund (UNICEF), the World Health Organization (WHO), the World Bank Group and the United Nations PopulationDivision. Differences between the estimates presented in this report and those in forthcoming publications by UN IGME membersmay arise because of differences in reporting periods or in the availability of data during the production process of each publicationand other evidence. UN IGME estimates were reviewed by countries through a country consultation process but are not necessarily theofficial statistics of United Nations Member States, which may use a single data source or alternative rigorous methods.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, WHO, the World Bank Group or the United Nations Population Division concerning the legal statusof any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines onmaps represent approximate border lines for which there may not yet be full agreement.United Nations Children’s Fund3 UN Plaza, New York, New York, 10017 USAWorld Health OrganizationAvenue Appia 20, 1211 Geneva 27, SwitzerlandWorld Bank Group1818 H Street, NW, Washington, DC, 20433 USAUnited Nations Population Division2 UN Plaza, New York, New York, 10017 USA
Levels & Trends inChild MortalityReport 2020Estimates developed by theUN Inter-agency Group forChild Mortality Estimation
CHILD SURVIVAL: KEY FACTS AND FIGURES In 2019, globally, 70 per cent of deathsamong children and youth under 25 years ofage occurred among children under 5 yearsof age, accounting for 5.2 (5.0, 5.6) milliondeaths. Among under-five deaths, 2.4 million(47 per cent) occurred in the first monthof life, 1.5 million (28 per cent) at age 1–11months, and 1.3 million (25 per cent) at age1 4 years. An additional 2.2 (2.2, 2.4) milliondeaths occurred among children and youngpeople aged 5 24 years in 2019, 43 per centof which occurred during the adolescentperiod, ages 10 19. The global under-five mortality rate fell to 38(36, 41) deaths per 1,000 live births in 2019from 93 (92, 95) in 1990 and 76 (75, 77) in2000 – a 59 (56, 61) per cent and 50 (46,52) per cent decline, respectively. In 2019,the neonatal mortality rate fell to 17 (17, 19)deaths per 1,000 live births from 37 (36, 38)in 1990 and 30 (30, 31) in 2000 – a 52 (48,55) per cent and 42 (37, 45) per cent decline,respectively. 4Despite dramatic reductions in child andyouth mortality over the last 30 years—under-five mortality has dropped by almost60 per cent since 1990—the global burdenof child and youth deaths remains immense.In 2019 alone, 7.4 (7.2, 7.9) million1 children,adolescents and youth died mostly ofpreventable or treatable causes.Among children and young people under 25years of age, the risk of dying was highest inthe first month of life, at an average rate of 17(17, 19) deaths per 1,000 live births globallyin 2019. In comparison, the probabilityof dying after the first month and beforereaching age 1 was 11 (10, 12) per 1,000 andthe probability of dying after reaching age 1and before reaching age 5 was 10 (9, 11) per1,000. For children, adolescents and youth aged5 24 years, the probability of dying islowest for young adolescents aged 10-14.Meanwhile, the risk of dying at any age 5-24is lower than for children under 5 years ofage. The probability a five-year-old would diebefore reaching age 10 was 4 (4, 4) deathsper 1,000; the probability a 10-year-old woulddie before reaching age 15 was 3 (3, 4)deaths per 1,000; the probability a 15-yearold would die before reaching age 20 was 5(5, 5) deaths per 1,000; and the probability a20-year-old would die before reaching age 25was 6 (6, 7) deaths per 1,000. The probabilityof dying after reaching age 5 and beforereaching age 25 was 18 (17, 19) deaths per1,000 in 2019, down from 31 (31, 33) deathsin 1990. The global number of under-five deathsdropped to 5.2 (5.0, 5.6) million in 2019 from12.5 (12.3, 12.7) million in 1990. On average,14,000 children died before age 5 every dayin 2019 compared to 34,000 in 1990 and27,000 in 2000. Among the 5.2 million underfive deaths in 2019, 2.8 (2.7, 3.0) million wereboys and 2.4 (2.3, 2.6) million were girls. About 6,700 newborns died every day in2019. The global number of neonatal deathsdeclined from 5.0 (4.9, 5.2) million in 1990 to
23 million 5-to-24-year-olds and 48 million childrenunder 5 years of age will die between 2020 and2030. Almost half of these under-five deaths willbe newborns whose deaths can be prevented byreaching high coverage of quality antenatal care,skilled care at birth, postnatal care for mother andbaby, and care of small and sick newborns.2.4 (2.3, 2.7) million in 2019, while neonatal deathsaccounted for a larger share of under-five deathsover time due to a faster global decline in mortalityamong children aged 1–59 months compared tochildren in their first month of life. In 2019, 47 (45,49) per cent of all under-five deaths occurred inthe neonatal period, up from 40 (39, 41) per centin 1990. Children continue to face widespread regionaldisparities in their chances of survival. SubSaharan Africa remains the region with the highestunder-five mortality rate in the world. In 2019, theregion had an average under-five mortality rateof 76 (71, 87) deaths per 1,000 live births. That isequivalent to 1 child in 13 dying before reachingage 5. This rate is 20 times higher than that of 1in 264 in the region of Australia and New Zealandand two decades behind the world average, whichachieved a 1 in 13 rate by 1999. The persistent and overwhelming burden of deathsamong children and youth highlights the urgentneed to further accelerate progress in preventingchild deaths. Current trends predict that close to In 2019, 122 countries had already achieved anunder-five mortality rate below the SustainableDevelopment Goal (SDG) target of 25 or fewerdeaths per 1,000 live births. Those countriesshould aim to maintain progress and furtherreduce disparities among their populations. Of theremaining 73 countries, progress will need to beaccelerated in 53 to reach the SDG target by 2030.Even more countries are projected to miss theneonatal mortality target by 2030—more than 60countries will need to accelerate progress to reachthe SDG neonatal mortality target on time. If all countries reach the SDG child survival targetsby 2030, 11 million lives under age 5 will besaved—more than half of them in sub-SaharanAfrica.5
IntroductionAt the time of writing, the novel coronaviruspandemic had reached every region of the world,with millions of infections globally and untolddisruptions to nearly every aspect of daily life.Among the many difficult realities underscoredby this pandemic and other life-threateningepidemics before it, such as HIV, is the precariousnature of mortality gains. Years of progressbrought about by concerted action and resourcedelivery can be undone by inaction or indirectdisruptions to care during a single protractedcrisis.While the extent and severity of the mortalityimpact of COVID-19 on children and youth is stillunknown, the potential of a mortality crisis in2020 threatens years of remarkable improvementin child and adolescent survival from 1990 to2019, the period covered in this report. The globalunder-five mortality rate declined by almost 60per cent from 93 deaths per 1,000 live births in1990 to 38 deaths in 2019. Meanwhile, mortalityamong adolescents aged 10–19 fell from 13deaths per 1,000 adolescents aged 10 in 1990 to8 deaths in 2019—a 39 per cent decrease. Evenwith that progress, some 5.2 million childrendied before reaching their fifth birthday in 2019alone. Tragically, many of those children died ofpreventable or treatable conditions.Even before COVID-19 captured the world’sattention and highlighted just how tenuousmortality decline can be, it was well understoodthat maintaining progress and saving even morelives would require mobilization of resourcesand monitoring. That understanding led to theinclusion of child survival goals in numerousglobal initiatives including the United NationsGlobal Strategy for Women’s Children’s andAdolescents’ Health (2016-2030)2 and theSustainable Development Goals (SDGs).3 The6SDGs call for ending preventable deaths ofnewborns and children under age 5, with allcountries aiming to have a neonatal mortality rateof 12 or fewer deaths per 1,000 live births and anunder-five mortality rate of 25 or fewer deaths per1,000 live births by 2030.If the child survival targets are to be met on time,resources and policy must be geared toward notonly sustaining current rates of decline but alsoaccelerating progress, which would save millionsof lives. If the trends from 2010 to 2019 continue,53 countries will not meet the SDG target onunder-five mortality on time—if all countries wereto meet that target, 11 million under-five deathswould be averted from 2020 to 2030. Achievingthe child survival goals and heading off a reversalof progress in child survival in 2020 will requireuniversal access to effective, high-quality andaffordable care and the continued, safe provisionof life-saving interventions for women, children,and young people.While the full extent of the coronaviruspandemic on child and youth mortality is yet tobe understood, it is already possible to anticipatethe impacts and lay the foundation for trackingand responding to them. If we are to comprehendthe true toll of this pandemic on child mortalityand to continue to effectively monitor progresstoward global goals, it is crucial to understandthe prevailing levels and trends in child mortality.Reliable estimates of child, adolescent andyouth mortality at the national, regional andglobal levels are essential for evidence-basedpolicymaking to improve the chances of survivalof the world’s children in the face of a globalpandemic.In the absence of reliable and continuallycollected vital registration data—the preferred
source for monitoring vital events—evidencebased estimation of child mortality remainsindispensable for monitoring child mortalitylevels and progress towards child survival goals.The United Nations Inter-agency Group forChild Mortality Estimation (UN IGME) producesestimates of child and adolescent mortalityannually, reconciling the differences across datasources and taking into account the systematicbiases associated with the various types of dataon child and adolescent mortality. This reportpresents the UN IGME’s latest estimates – through2019 – of neonatal, infant and under-five mortalityas well as mortality among children and youngadolescents aged 5–14 years. This report alsopresents the inaugural set of mortality estimatesamong youth aged 15–24. It assesses progressin the reduction of child, adolescent and youthmortality at the country, regional and globallevels, and provides an overview of the methodsused to estimate the indicators mentioned above.The estimates and analysis presented in thisreport provide the foundation for monitoringchanges in mortality, including the impact of theCOVID-19 pandemic, which itself serves as a callfor further disaggregated data as evidence of thedifferential impact of the virus emerges.7
Levels and trendsin child mortalityGlobal progress in reducing child mortalityhas been remarkable. The global under-fivemortality rate has declined by almost 60 per centsince 1990 to 38 deaths per 1,000 live births in2019. As a result, millions more children surviveto adolescence today than they did in 1990 (seeFigure 1 and Figure 2).5—almost half of those deaths (2.4 million) wereamong newborns. Among all deaths over age 5,adolescents aged 10–19 accounted for 1 million,children aged 5–9 for 0.5 million and youth aged20–24 for 0.8 million (see Figure 1 and Figure 2).While young people and older adolescents facean increasing risk of dying with age, newbornsface the greatest risk of dying among childrenunder age five. The age distribution of mortalityamong children and youth shows that the riskof mortality is highest during the first 28 daysof life, the neonatal period, before decreasingfor older children and young adolescents (ages5–14), then increasing with age among youth agedAgainst this backdrop of progress, the burdenof child deaths remains unconscionable—7.4million children and young people under theage of 25 died in 2019 alone. Compoundingthis tragedy, these children and young peopledied mostly of preventable causes. Some 5.2million children died before reaching ageFIGURE1Global mortality rates and number of deaths by age, 2019Mortality ratesNumber of deaths(in millions and percentage share)40Youth aged 20–24 years0.8 (10%)38Older adolescentsaged 15–19 yearsYoungasolescentsaged 10–14years0.4 (5%)Deaths per 1,000302.2 (30%)Children aged 5–9 years0.5 (7%)Children aged1–4 years1.3 (17%)201817Children aged1–11 months1.5 (20%)1110104Neonatal(0–27days)Childrenaged 1–11monthsChildrenaged 1–4yearsChildrenaged 5 9years5Neonatal(0–27 days)62.4 (33%)3YoungOlderYouthasolescents adolescents aged 20–24aged 10–14 aged 15–19yearsyearsyearsNote: All figures are based on unrounded numbers.80.6 (8%)Children andyouth aged5–24 yearsUnder-five Children andyouth aged5–24 yearsUnder-five5.2 (70%)
Southern Asia with 1.5 million (28 per cent). Theregions of Australia and New Zealand, Easternand South-Eastern Asia, Northern Africa andWestern Asia, Europe and Northern America,Latin America and the Caribbean, and Oceania(excluding Australia and New Zealand) accountfor the remaining 19 per cent of under-fivedeaths. Sub-Saharan Africa also bears the bruntof deaths among children and young people olderthan age 5, accounting for 44 per cent of deathsage 5–24.15–24. In 2019, the neonatal mortality rate wasestimated to be 17 deaths per 1,000 live births.The probability of dying after the first monthand before reaching age 1 was estimated to be11 per 1,000, and the probability of dying afterreaching age 1 and before reaching age 5 was10 per 1,000. For children and youth over age 5,the probability a five-year-old would die beforereaching age 10 was estimated to be 4 deaths per1,000 children aged 5, while the probability a10-year-old would die before reaching age 15 waslowest among all 5-year age groups at 3 deathsper 1,000 adolescents aged 10. The probability ofdying after reaching age 15 and before age 20 wasestimated to be 5 deaths per 1,000 adolescentsaged 15, and after reaching 20 and before 25, theprobability again increases to 6 deaths per 1,000youths aged 20 (see Figure 1).Over the last three decades, the under-fivemortality rate declined fastest from 2000 to2009, while the pace of decline quickened forchildren and young adolescents in the mostrecent decade. Globally, the annual rate ofreduction (ARR)4 in under-five mortality doubledfrom 1.9 (1.7, 2.1) per cent in 1990-1999 to 4.0(3.7, 4.2) per cent in 2000-2009, before slowingslightly to 3.4 (2.6, 3.9) per cent in 2010-2019 (seeFigure 3).5 The trend in global neonatal mortalityfollowed a similar pattern, increasing from 1.8The burden of child deaths is uneven acrossregions. In 2019, sub-Saharan Africa carried morethan half of that burden with 2.8 million underfive deaths (53 per cent), followed by Central andFIGUREGlobal mortality rates and number of deaths by age, 1990–20192Mortality rates100Number of 2019Deaths (in millions)Deaths per 99520002005201020152019Under five mortality rateMortality rate among adolescents aged 10 19Under five deathsDeaths among adolescents aged 10 19Neonatal mortality rateMortality rate among children and youth aged 5 24Neonatal deathsDeaths among children and youth aged 5 24Note: All figures are based on unrounded numbers. The solid line in the left panel represents the median estimate and the shaded area represents the 90 per centuncertainty bound around the median value.9
Annual rate of reduction (per cent) in mortality rate by age group and Sustainable DevelopmentGoal region in 1990-1999, 2000-2009, 2010-2019 5FIGURE3Sub Saharan AfricaOceania (exc. Australia and New Zealand)66444222000 2 2 21990 19992000 20092010 20191990 1999Northern Africa and Western AsiaPer cen
by the United Nations Children’s Fund ISBN: 978-92-806-5147-8 The United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) constitutes representatives of the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), the World Bank Group and the United Nations Population Division.
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