Child Mortality & Sustainable Development
The 17 Sustainable Development Goals were adopted in 2015 and are supposed to be met by the countries by 2030. Of the 17 SDGs, the 3rd one seeks to achieve “Good Health and Well-being”. Child mortality is a major health indicator and comes in the domain of target 3.2 under this goal.
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What is Child Mortality Rate (CMR)?
Child Mortality Rate is a measure of deaths of children below the age of five. Hence, it is also referred to as under-five mortality rate and is expressed as per 1,000 live births. Neo-natal mortality (deaths within 28 deaths of birth) and infant mortality (deaths within 1 year of birth) are included under Child Mortality Rate.
The target 3.2 of SDGs aims to end preventable deaths of newborns and children under 5 years of age by the year 2030. For all the countries, the target is set to reduce neonatal mortality to at least 12 deaths per 1,000 live births and under-5 mortality to at least s 25 deaths per 1,000 live births. This implies that 97.5% of all newborns should survive the first five years of their life irrespective of their time and place of birth.
An overview of worldwide Child Mortality Rate
- There has been remarkable progress in the reduction of child mortality since 1990. The total number of under-5 deaths was 12.6 million in 1990 which decreased to 5.2 million in 2019. In other words, there has been a reduction of 60% in the under-5 mortality from 93 deaths per 1000 live births in 1990 to 38 deaths per 1000 live births in 2019. Both the under-five mortality rate and the number of under-five deaths have fallen by more than half since 1990.
- The number of neonatal deaths across the world stood at 5.0 million which declined to 2.4 million in 2019. However, the decline in neonatal mortality between 1990 and 2019 has occurred at a slower rate than post-neonatal under-5 mortality.
- Despite great progress through time, the world is still far away from achieving the SDG target 3.2 by 2030. As of 2019, 3.9% of children across the world face deaths before the age of 5 years. It means that on average 15,000 children below 5 years and 7,000 newborns die every day. In 2020, a total of 5.0 million children under 5 years of age died. It implies that 13,800 children or 1,200 lesser number of under-five children died every day in 2020 as compared to that of 2019.
- Since 2020, COVID-19 has adversely affected child mortality worldwide. UNICEF data provided in January 2022 revealed that out of 3.5 million COVID deaths 12,300 occurred to people less than 20 years of age. Of 12,3000, 42 percent occurred to children aged 0-9 years.
Spatial overview: As per the WHO data
- Under-5 mortality is most widely prevalent in middle and low-income countries. Sub-Saharan Africa is the region that has the world’s highest under-five mortality rate of 74 deaths per 1,000 live births. In 2020, 1 in 13 children in Sub-Saharan Africa breathed their last before attaining five years of age —15 times higher than the risk for children born in high-income countries and 19 years behind the world average, which was 1 in 13 children by 2001. In Sub-Saharan Africa, however, the share of neonatal deaths among child mortality is comparatively lower (36 percent).
- After Sub-Saharan Africa comes South Asia. In 2020, approximately, 82 percent of all under-five mortality across the world occurred in these two regions: sub-Saharan Africa (55 percent) and South Asia (27 percent). In South Asia, the share of neonatal deaths in under-five mortality is among the highest (62 percent).
- Half of all under-five deaths in 2019 occurred in just five countries: Nigeria, India, Pakistan, the Democratic Republic of the Congo, and Ethiopia. Nigeria and India alone account for almost a third of all deaths.
- On the contrary, in the European region, the under-five mortality is only 8 per 1,000 live births. Europe and Northern America, where the under-five mortality rates are the lowest among SDG regions, 54 percent occur during the neonatal period.
Reasons behind high child mortality
- WHO reports 18% mortality due to pre-term birth complications (18%): Preterm births refer to the occurrence of live births before 37 weeks of pregnancy are completed. Every year, about 15 million babies suffer pre-term births and this number is on a rise. In 2015, it resulted in 1 million deaths. This happens because of various factors like multiple pregnancies, chronic diseases like diabetes, infections, genetic influence, induction of labor, cesarean birth, etc. Sadly, India is the country with the highest number of pre-term births (3 519 100) followed by China, Nigeria, and Pakistan. The highest rates of this issue are experienced by Malawi (18.1 per 1000 live births) followed by Comoros, Congo, Zimbabwe.
- Diseases, disorders, and infections: Infectious diseases, including pneumonia, diarrhea, malaria are the leading causes of under-5 mortality. (1) Diarrhoea is the second leading cause of mortality in children under five years. Each year diarrhea kills around 525 000 children under five. (2) Children under 5 years of age are considerably at higher of getting affected and dying from malaria. (3) Pneumonia killed 740 180 children under the age of 5 in 2019, accounting for 14% of all deaths of children under five years old.
- Neonatal tetanus (cause of deaths for children with age between 4-14 days)
- Neonatal sepsis or a blood infection (cause of deaths for children either within 7 days of birth or after 7 days of birth)
- Congenital abnormality or malformation at birth (cause of deaths for children within 29 days of birth)
- Birth asphyxia or lack of breathing (cause of deaths for children with the age of a month) Underweight during birth (cause of deaths for children within 29 days of birth)
- Malnutrition: UNICEF & Borgen Project observes that approximately 50% of the total number of deaths in children under 5 occur due to undernutrition. Malnutrition makes the health of children under five years vulnerable and often leads to common infections and diseases like diarrhea, malaria, and pneumonia, increases the frequency and severity of such infections which become very difficult to recover. Malnutrition in the first 1,000 days of a child’s life can also lead to stunted growth, which in turn causes impaired cognitive ability and stagnated school and work performance. In areas like South Africa malnutrition is an issue affecting 64 percent of infants. Lack of breastfeeding or mixed-feeding practices often cause a shortage of nutrition in infants and leads to their untimely deaths.
- Lack of access to basic life saving equipment: The lack of access to the following life-saving facilities also causes significant child mortality:
- Professional or skilled delivery during birth and postnatal care: In 2010 approximately 2,87,000 women died while pregnant or during giving birth and 3.1 million newborns die in the neonatal period due to lack of of the mentioned facilities (WHO)
- Vaccinations: New vaccines and an expansion of vaccination programs have remarkably reduced childhood deaths in low- and middle-income nations for the last 10 years but there is still a long way to go.
- Treatment for common childhood diseases: Not having access to doctors and other health facilities can aggravate common diseases in children and become their cause of mortality.
Initiatives taken to get rid of child mortality
- As under nutrition continues to be a major cause of global child mortality, programmes of the United Nation’s Food and Agricultural Organization (FAO) seek to help poor families and communities to have secure access to nutritionally sufficient for reducing under nutrition of their children. Their activities include community-centred initiatives, education programmes for spreading awareness about nutrition, training programmes for national and local staff, and the promotion of a forum on household food security and community nutrition.
- The targets to reduce child mortality have been translated into the “Global Strategy for Women’s, Children’s and Adolescent’s Health” (Global Strategy), which aims to get rid of child deaths from preventable causes while addressing emerging child health priorities.
- WHO appeals to its Member States to address the issue of health equity through universal health coverage so that all children are able to access necessary health services without undue financial hardships.
Suggestions to reduce child mortality
As per WHO, the following are the best ways to reduce child mortality:
- Immediate and adequate breastfeeding to ensure the health of children
- Assistance by skilled attendants (doctors, midwives, nurses) during antenatal, birth, and postnatal care. Midwife-led continuity of care (MLCC) can reduce preterm births by up to 24%. (MLCC is a system of care in which a midwife gives care to a woman throughout her pregnancy, childbirth, and the postnatal period, and seeks medical support if necessary.)
- Provision of thermal protection, hygienic umbilical cord, and skincare.
- The facility of additional healthcare in case of serious issues like low-birth-weight, HIV-infected mothers.
- Timely vaccinations to the children as per national schedule
- Access to nutrition and micronutrients
- Access to clean water, sanitation, and hygienic conditions
It is high time that efforts must begin at the individual level to reduce child mortality rates worldwide to make sure that we lead a happy and healthy life and don’t lag behind in achieving the Sustainable Development Goals. We should come together now to save ourselves and our planet.
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