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Child Mortality
Report 2011
Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation
This report was prepared at UNICEF Headquarters by Danzhen You, Gareth Jones and Tessa Wardlaw on behalf of the UnitedNations Interagency Group for Child Mortality Estimation. Organizations and individuals involved in generating country-specific estimates on child mortality United Nations Childrens Fund Danzhen You, Tessa Wardlaw World Health Organization Ties Boerma, Colin Mathers, Mie Inoue, Mikkel Oestergaard The World Bank Emi Suzuki United Nations Population Division Francois Pelletier, Gerhard Heilig, Kirill Andreev, Patrick Gerland, Danan Gu, Nan Li, Cheryl Sawyer, Thomas Spoorenberg United Nations Economic Commission for Latin America and the Caribbean Population Division Dirk Jaspers Faijer, Guiomar Bay, Tim Miller Special thanks to the Technical Advisory Group of the Inter-agency Group for Child Mortality Estimation for providing technical guidance on methods for child mortality estimation Kenneth Hill (Chair), Harvard University Leontine Alkema, National University of Singapore Simon Cousens, London School of Hygiene and Tropical Medicine Trevor Croft, Measure DHS, ICF Macro Gareth Jones, Consultant Michel Guillot, University of Pennsylvania Jon Pedersen, Fafo Neff Walker, Johns Hopkins University John Wilmoth, University of California, Berkeley
Further thanks go to Priscilla Akwara, Mickey Chopra, Archana Dwivedi, Jimmy Kolker, Richard Morgan, Holly Newby and Ian Pett from UNICEF for their support as well as to Joy Lawn from Save the Children for her comments. And special thanks to Mengjia Liang from UNICEF for her assistance in preparing the report. Communications Development Incorporated provided overall design direction, editing and layout. Copyright 2011 by the United Nations Childrens Fund The Interagency Group for Child Mortality Estimation (IGME) constitutes representatives of the United Nations Childrens Fund, 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 will be updated by the IGME. Differences between the estimates presented in this report and those in forthcoming publications by IGME members may arise because of differences in reporting periods or in the availability of data during the production process of each publication and other evidence. While every effort has been made to maximize the comparability of statistics across countries and over time, users are advised that country data may differ in terms of data collection methods, population coverage and estimation methods used. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNICEF, the World Health Organization, the World Bank or the United Nations Population Division concerning 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 the United Nations on 14 July 2011; disaggregated data for Sudan and South Sudan as separate states are not yet available. Data and maps in this report refer to Sudan as it was constituted in 2010. United Nations Childrens Fund 3 UN Plaza, New York, New York, 10017 USA The World Bank 1818 H Street, NW, Washington, DC, 20433 USA World Health Organization Avenue Appia 20, 1211 Geneva 27, Switzerland United Nations Population Division 2 UN Plaza, New York, New York, 10017 USA
Introduction
Only four years remain to achieve Millennium Development Goal 4 (MDG 4), which calls for reducing the under-five mortality rate by twothirds between 1990 and 2015. Since 1990 the under-five mortality rate has dropped 35 percent, with every developing region seeing at least a 30 percent reduction. However, at the global level progress is behind schedule, and the target is at risk of being missed by 2015. The global underfive mortality rate needs to be halved from 57 deaths per 1,000 live births to 29that implies an average rate of reduction of 13.5 percent a year, much higher than the 2.2 percent a year achieved between 1990 and 2010. Child mortality is a key indicator not only of child health and nutrition but also of the implementation of child survival interventions and, more broadly, of social and economic development. As global momentum and investment for accelerating child survival grow, monitoring progress at the global and country levels has become even more critical. The United Nations Inter-agency Group for Child Mortality Estimation (IGME) updates child mortality estimates annually for monitoring progress. This report presents the IGMEs latest estimates of under-five, infant and neonatal mortality and assesses progress towards MDG 4 at the country, regional and global levels.
The UN Inter-agency Group for Child Mortality Estimation The 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 Childrens Fund (UNICEF) and the World Health Organization (WHO), also includes the World Bank and the United Nations Population Division of the Department of Economic and Social Affairs as full members.
The IGMEs independent Technical Advisory Group, comprising leading academic scholars and independent experts in demography and biostatistics, provides guidance on estimation methods, technical issues and strategies for data analysis and data quality assessment. Generating accurate estimates of child mortality poses a considerable challenge because of the limited availability of high-quality data for many developing countries. Complete vital registration systems are the preferred source of data on child mortality because they collect information as events occur and they cover the entire population. However, many developing countries lack fully functioning vital registration systems that accurately record all births and deaths. Therefore, household surveys, such as the UNICEFsupported Multiple Indicator Cluster Surveys and the US Agency for International Development supported Demographic and Health Surveys, are the primary sources of data on child mortality in developing countries. The IGME seeks to compile all available nationallevel data on child mortality, including data from vital registration systems, population censuses, household surveys and sample registration systems. To estimate the under-five mortality trend series for each country, a statistical model is fitted to data points that meet quality standards established by the IGME and then used to predict a trend line that is extrapolated to a common reference year, set at 2010 for the estimates in this report. To predict infant mortality rates, model life tables are used to transform under-five mortality rates. To predict neonatal mortality rates, a
Changes to data sources and methodology The IGME updates its child mortality estimates annually after reviewing newly available data and assessing data quality. In preparing the estimates in this report, the IGME recalculated direct estimates from all available Demographic and Health Surveys for calendar year periods, using single calendar years for reference periods shortly before the survey and then gradually increasing the number of years for reference periods further in the past. For a given survey the cut-off points for shifting from estimates for single calendar years to two years, or two years to three and so on are based on the coefficients of variation (a measure of sampling uncertainty) of the estimates. The Technical Advisory Group suggested this recalculation because the sample sizes of many household surveys have grown in recent years, allowing for shorter reference periods. The recalculated direct estimates with shorter reference periods replace the five-year periods used in previous estimations, thereby increasing the number of data points for more recent years.
In addition, a substantial amount of newly available data has been incorporated: data from the most recent surveys and censuses for about 30 countries, new data from vital registration systems for more than 50 countries and data from more than 70 surveys and censuses conducted before 2000 for about 20 countries. The increased data availability has resulted in substantial changes in the estimates for some countries from previous years. Because the fitted under-five mortality rate trend line is based on the entire time series of data available for each country and because model life tables and a statistical model are used to derive estimates of infant and neonatal mortality rates based on under-five mortality rates, the estimates presented in this report may differ from and not be comparable with previous sets of IGME estimates and the most recent underlying country data. Furthermore, this year the IGME used a different curve-fitting methodology. More details on the data and methods used in deriving the estimates are available in the IGMEs child mortality database, CME Info (www.childmortality.org).
3
Support for data collection at country level Modelled estimates of child mortality can only be as good as the underlying data. The IGME members, including UNICEF, the WHO and other UN agencies, are actively involved at the country level in strengthening national capacity in data collection, estimation techniques and interpretation of results.
Population-based survey data are critical for developing sound estimates for countries lacking functioning vital registration systems. The UNICEF-supported Multiple Indicator Cluster Surveys programme has been working since 1995 to build country-level capacity for survey implementation, data analysis and dissemination. The surveys are government owned and implemented, and UNICEF provides financial and technical support through workshops, technical consultations and peer-to-peer mentoring. More than 230 surveys have been conducted in more than 100 countries. In addition to population-based surveys, the WHO and the UN Statistics Division work with countries to strengthen vital registration systems. UNICEF supports this work by promoting birth registration and monitoring its progress. The United Nations Population Fund provides technical assistance for population censuses, another important source of child mortality data. The IGME strengthens capacity by working with countries to improve understanding of child
mortality data and estimation. CME Info (www. childmortality.org ), a comprehensive data portal on child mortality funded by UNICEF and launched by the IGME, is a powerful platform for sharing underlying data and collaborating with national partners on child mortality estimates. Since 2008 a series of regional workshops has been held, training more than 250 participants from 94 countries in the use of CME Info as well as the demographic techniques and modelling methods underlying the estimates. In the last three years UNICEF and the IGME have sent experts to about 10 countries to conduct training on child mortality estimation. As part of the data review process, UNICEFs network of field offices provides opportunities to assess the plausibility of estimates by engaging in a dialogue about the estimates and the underlying data. WHO also engages its Member States in a country consultation process through which governments provide feedback on the estimates and their underlying data. Guiding this capacity strengthening work is a fundamental principle: child mortality estimation is not simply an academic exercise but a fundamental part of effective policies and programming. UNICEF works with countries to ensure that child mortality estimates are used effectively at the country level, in conjunction with other data on child health, to improve child survival programmes and stimulate action through advocacy. This work involves partnering with other agencies, organizations, and initiatives such as the Countdown to 2015.
TAblE
levels and trends in the under-five mortality rate, by Millennium Development Goal region, 19902010 (deaths per 1,000 live births)
Average annual rate of reduction (percent) 19902010 Progress towards Millennium Development Goal4 target 2010
Region
1990
1995
2000
2005
2009
2010
Developed regions Developing regions Northern Africa Sub-Saharan Africa Latin America and the Caribbean Caucasus and Central Asia Eastern Asia Excluding China Southern Asia Excluding India South-eastern Asia Western Asia Oceania World
10 80 47 154 35 62 33 30 87 91 48 45 63 73
8 71 35 138 27 53 25 19 75 80 39 38 57 65
7 64 28 124 22 47 19 18 67 73 34 33 53 58
7 63 27 121 23 45 18 17 66 72 32 32 52 57
5 32 27 58 18 26 16 9 39 41 24 22 25 29
53 35 67 30 57 42 63 39 44 41 55 52 31 35
3.8 2.2 5.6 1.8 4.3 2.7 4.9 2.5 2.9 2.7 4.0 3.7 1.8 2.2
On track Insufficient progress On track Insufficient progress On track Insufficient progress On track On track Insufficient progress Insufficient progress On track On track Insufficient progress Insufficient 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 over 19902010; 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 at least 1 percent but less than 4 percent over 19902010. These standards may differ from those in other publications by Inter-agency Group for Child Mortality Estimation members.
TAblE
levels and trends in the number of deaths of children under age five, by Millennium Development Goal region, 19902010 (thousands)
Share of global under-five deaths (percent) 2010
Region
1990
1995
2000
2005
2009
2010
Developed regions Developing regions Northern Africa Sub-Saharan Africa Latin America and the Caribbean Caucasus and Central Asia Eastern Asia Excluding China Southern Asia Excluding India South-eastern Asia Western Asia Oceania World
227 11,782 304 3,734 623 155 1,308 29 4,521 1,443 853 270 14 12,010
151 10,550 210 3,977 511 119 845 46 3,930 1,233 696 247 15 10,702
129 9,446 153 4,006 397 86 704 30 3,354 1,060 530 201 15 9,575
112 8,355 121 3,956 305 80 423 16 2,829 875 453 173 14 8,467
102 7,654 100 3,752 237 79 349 17 2,588 837 368 167 14 7,756
56 36 69 1 60 50 75 41 44 42 59 39 0 37
1.3 98.7 1.2 48.7 3.3 1.0 4.3 0.2 33.2 10.9 4.6 2.2 0.2 100.0
FiGuRE
FiGuRE
Under-ve mortality rate, by Millennium Development Goal region, 1990 and 2010 (deaths per 1,000 live births) 200
174
Many regions have reduced the under-five mortality rate by at least 50percent between 1990 and 2010
Decline in under-ve mortality rate, by Millennium Development Goal region, 19902010 (percent) 75
67 63 57 121
150
117
55
50
97 82 88 42
52
100
75 77 71
44
35
53 31
66
67
63
52
54
50
45
48
57
25
32 32 27 23 18 15
Sub-Saharan Africa
South-eastern Asia
Western Asia
Northern Africa
Southern Asia
Eastern Asia
Oceania
Developed regions
Developing regions
World
Northern Africa
South-eastern Asia
Western Asia
Sub-Saharan Africa
Eastern Asia
Southern Asia
Oceania
Developing regions
1990
2010
FiGuRE
FiGuRE
Number of under-ve deaths, by Millennium Development Goal region, 2010 (thousands) Developed regions 99 Western Asia 165 Latin America and the Caribbean 249 Eastern Asia 331 South-eastern Asia 349
Share of under-ve deaths, by Millennium Development Goal region, 19902010 (percent) Developed regions Northern Africa Western Asia Caucasus and Central Asia Oceania 100 Latin America and the Caribbean Eastern Asia 80 South-eastern Asia
60 Southern Asia Sub-Saharan Africa 3,709 Southern Asia 2,526 20 Sub-Saharan Africa
40
1990
1995
2000
2005
Developed regions
World 2010
30
35
MAP
Children in Southern Asia and Sub-Saharan Africa face a higher risk of dying before their fifth birthday
Under-ve mortality rate (deaths per 1,000 live births) Less than 40 4099 100149 150 or more Data 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-five mortality, 14 have seen reductions of at least 50 percent between 1990 and 2010
FiGuRE
58
57
India 1,696
55 55 54
63
61
60
59
50
25 Dem. Rep. of the Congo 465 Pakistan 423 China 315 Ethiopia 271
51
51
Uganda 141 Sudana 143 Lao Peoples Democratic Republic Madagascar Timor-Leste Bangladesh Nepal Bhutan Malawi Cambodia Eritrea Bolivia Liberia Niger United Republic of Tanzania Azerbaijan 0 Indonesia 151 Afghanistan 191
a. Data refer to Sudan as it was constituted in 2010, before South Sudan seceded on 9 July 2011.
As under-five mortality rates have fallen more sharply in richer developing regions, the disparity between Sub-Saharan Africa and other regions has grown. In 1990 a child born in Sub-Saharan Africa faced a probability of dying before age 5 that was 1.5 times higher than in Southern Asia, 3.2 times higher than in Latin America and the Caribbean, 3.6 times higher than in Eastern Asia and 11.6 times higher than in developed regions. By 2010 that probability was 1.8 times higher than in Southern Asia, 5.3 times higher than in Latin America and the Caribbean, 6.7 times higher than in Eastern Asia and 17.3 times higher than in developed regions. The disparity between Southern Asia and richer regions has also grown, though not as much. Of the 66 countries with at least 40 deaths per 1,000 live births in 2010, only 11 are on track to achieve MDG 4 (map 2). But substantial advances have been made, particularly in Sub-Saharan Africa. Six of the fourteen best-performing countries are in Sub-Saharan Africa (see figure 5), as are four of the five countries with the largest absolute reductions in under-five mortality. Thus, there is increasing evidence that MDG 4 can be achieved, but only if countries in Sub-Saharan
MAP
Africa and Southern Asia give high priority to reducing child mortality, particularly by targeting the major killers of children (including pneumonia, diarrhoea, malaria and undernutrition) with effective preventative and curative interventions.
Neonatal mortality
Neonatal mortality, covering deaths in the first month after birth, is of interest because the health interventions needed to address the major causes of neonatal deaths generally differ from those needed to address other under-five deaths. Neonatal mortality is increasingly important because the proportion of under-five deaths that occur during the neonatal period is increasing as under-five mortality declines. Over the last two decades almost all regions have seen slower declines in neonatal mortality than in under-five mortality. Globally, neonatal mortality has declined 28 percent from 32 deaths per 1,000 live births in 1990 to 23 in 2010an average of 1.7 percent a year, much slower than for under-five mortality (2.2 percent per year) and for maternal mortality (2.3 percent per year). The fastest reduction was in Northern Africa (55 percent), followed by Eastern Asia and Latin America and the Caribbean (52 percent); the
Many countries were on track in 2010 to achieve Millennium Development Goal 4, but progress needs to accelerate in several regions, particularly in Southern Asia and Sub-Saharan Africa
On track: under-ve mortality is less than 40 deaths per 1,000 live births in 2010 or the average annual rate of reduction of under-ve mortality is at least 4 percent over 19902010. Insufcient progress: under-ve mortality is at least 40 deaths per 1,000 live births in 2010 and the average annual rate of reduction is at least 1 percent but less than 4 percent over 19902010.
No progress: under-ve mortality is at least 40 deaths per 1,000 live births in 2010 and the average annual rate of reduction is less than 1 percent over 19902010. Data not available.
Note: These standards may differ from those in other publications by Inter-agency Group for Child Mortality Estimation members. Data for Sudan refer to the country as it was constituted in 2010, before South Sudan seceded on 9 July 2011.
slowest reduction was in Oceania and Sub-Saharan Africa (19 percent; table 3). Over the same period the share of neonatal deaths among under-five deaths has increased from about 37 percent to slightly above 40 percent worldwide and is expected to further increase as under-five mortality declines. While the relative increase is modest (9 percent) at the global level, there are differences across regions. The largest increases have been in Northern Africa (37 percent) and Eastern Asia (27 percent), the smallest in Oceania (7 percent; see table 3). In Eastern Asia, which had one of the largest declines in under-five mortality, neonatal deaths accounted for 57 percent of under-five deaths in 2010. Eastern Asia, Northern Africa and other richer developing regions will have to pay more attention to health interventions that address neonatal mortality in order to continue their success in reducing under-five mortality. Southern Asia also needs to address neonatal mortality: neonatal deaths account for 50 percent of under-five deaths, and almost 30 percent of global neonatal deaths occurred in India. Sub-Saharan Africa, which accounts for more than a third of global neonatal deaths, has the highest neonatal mortality rate (35 deaths per
TAblE
1,000 live births in 2010) and has shown the least progress in reducing that rate over the last two decades. With the proportion of under-five deaths during the neonatal period increasing in every region and almost all countries, systematic action is required by governments and partners to reach women and babies with effective care. Highly cost-effective interventions are feasible even at the community level, and most can be linked with preventive and curative interventions for mothers and for babies. For example, early postnatal home visits are effective in promoting healthy behaviours such as breastfeeding and clean cord care as well as in reaching new mothers. Case management of neonatal infections can be provided alongside treatment of childhood pneumonia, diarrhoea and malaria. Care at birth brings a triple return on investment, preventing stillbirths and saving mothers and newborns.
Disparity in child mortality Despite substantial progress in reducing underfive deaths, children from rural and poorer households remain disproportionately affected. Analyses based on data from household surveys for a subset of countries indicate that children in rural areas are about 1.7 times as likely to die
neonatal mortality rate, number of neonatal deaths and neonatal deaths as a share of under-fivedeaths, by Millennium Development Goal region, 1990 and 2010
Neonatal mortality rate (deaths per 1,000 live births) Decline (percent) 19902010 Number of neonatal deaths Neonatal deaths as a share of under-five deaths (thousands) (percent) Relative increase (percent) 19902010
Region
1990
2010
1990
2010
1990
2010
Developed regions Developing regions Northern Africa Sub-Saharan Africa Latin America and the Caribbean Caucasus and Central Asia Eastern Asia Excluding China Southern Asia Excluding India South-eastern Asia Western Asia Oceania World
7 36 29 43 23 30 23 12 48 48 28 28 26 32
4 25 13 35 11 21 11 9 32 33 15 16 21 23
43 31 55 19 52 30 52 25 33 31 46 43 19 28
106 4,319 107 969 265 58 589 14 1,875 576 335 116 5 4,425
47 37 35 26 42 37 45 47 41 40 39 43 37 37
53 40 49 30 47 44 57 48 50 46 48 48 40 40
15 10 37 17 11 18 27 1 20 15 23 12 7 9
10
before their fifth birthday as those in urban areas and that children from the poorest 20 percent of households are nearly twice as likely to die before their fifth birthday as children in the richest 20 percent of households (figure 7). Similarly, mothers education remains a powerful determinant of inequity. Children of educated motherseven mothers with only primary educationare more likely to survive than children of mothers with no education (see figure 7). Accelerating the decline in under-five mortality is possible by expanding interventions that target the main causes of deaths and the most vulnerable newborn babies and children. Empowering women, removing financial and social barriers to accessing basic services, developing innovations that make the supply of critical services more available to the poor and increasing local accountability of health systems are examples of policy interventions that have allowed health systems to improve equity and reduce mortality. An equity-focused approach could bring vastly improved returns on investment by averting far more child deaths and episodes of undernutrition and by markedly expanding effective coverage of key primary health and nutrition interventions.
FiGuRE
Children who live in poorer households and rural areas and whose mothers have less education are at higher risk of dying before age 5
Under-ve mortality rate, by wealth quintile, residence and mothers education, 20002010 (deaths per 1,000 live births) 150
146 121 114 101 114 90 62 67 91
120
90
30
Poorest
Second
Fourth
Richest
Middle
Urban
Wealth
Residence
Mothers education
Note: Calculation is based on 39 countries with most recent Demographic and Health Surveys conducted after 2005, with further analyses by UNICEF for under-ve mortality rates by wealth quintile, 45 countries for rates by residence and 40 countries for rates by mothers education. The average was calculated based on under-ve mortality rates weighted by number of births. Country-specic estimates obtained from Demographic and Health Surveys refer to a 10-year period prior to the survey. Because levels or trends may have changed since then, caution should be used in interpreting these results.
Secondary or higher
Rural
None
Primary
51
60
11
StatiStical table
country, regional and global estimates of under-five, infant and neonatal mortality
Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate (deaths per 1,000 live births) Number of neonatal deaths (thousands)
Under-five mortality rate (deaths per 1,000 live births) Millennium Development Average annual Goal rate of reduction targetfor (percent) 2010 2015 19902010 149 18 36 4 161 8 14 20 5 4 46 16 10 48 20 6 4 17 115 56 54 8 48 19 7 13 176 142 51 136 6 36 159 173 9 18 19 86 93 9 10 123 6 6 70 14 23 3 81 9 9 18 3 3 31 7 6 48 6 6 3 15 59 46 40 6 20 20 4 7 68 61 40 46 3 20 55 69 6 16 12 42 39 7 6 50 4 4 1.7 4.1 3.2 4.1 2.1 5.9 3.3 5.1 2.9 4.1 3.5 1.6 2.7 5.5 0.5 5.2 4.6 4.8 2.2 4.5 4.0 4.3 1.0 5.7 2.7 2.6 0.8 1.3 4.3 0.0 1.4 2.5 0.2 0.9 3.7 4.9 3.3 1.9 1.1 4.0 2.7 1.0 3.9 3.9
Country or territory Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Cte d'Ivoire Croatia Cuba
1990 209 41 68 9 243 26 27 55 9 9 93 22 17 143 18 17 10 44 178 139 121 19 59 59 12 22 205 183 121 137 8 59 165 207 19 48 37 125 116 20 17 151 13 13
1990 53 17 29 3 51 13 15 26 5 4 31 9 6 55 9 7 4 18 40 45 39 12 22 28 7 11 41 49 38 34 4 21 43 45 9 24 20 40 33 9 10 46 8 7
2010 45 9 18 1 41 4 7 11 3 2 19 7 4 27 10 3 2 8 32 26 23 5 19 12 4 7 38 42 22 34 4 14 42 41 5 11 12 32 29 5 6 41 3 3
2010 62 0 13 0 33 0 5 1 1 0 4 0 0 83 0 0 0 0 11 0 6 0 1 36 0 0 27 12 7 24 1 0 7 20 1 181 11 1 4 0 0 27 0 0
12
country, regional and global estimates of under-five, infant and neonatal mortality
Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate (deaths per 1,000 live births) Number of neonatal deaths (thousands)
Under-five mortality rate (deaths per 1,000 live births) Millennium Development Average annual Goal rate of reduction targetfor (percent) 2010 2015 19902010 4 4 33 170 4 91 12 27 20 22 16 121 61 5 106 17 3 4 74 98 22 4 74 4 11 32 130 150 30 165 24 6 2 63 35 26 39 4 5 4 24 4 5 15 60 3 41 6 21 17 31 21 63 47 7 61 10 2 3 31 55 16 3 41 4 7 26 76 70 22 50 19 6 2 38 28 22 15 3 4 3 13 5.1 6.3 1.6 0.3 4.1 1.5 1.7 4.2 4.8 7.3 6.8 2.3 4.2 7.2 2.8 2.8 4.2 4.1 1.1 2.6 3.8 4.1 2.5 5.9 3.2 4.5 2.8 1.7 3.9 0.4 4.4 5.8 5.5 3.0 4.4 4.6 0.8 4.1 4.4 4.6 2.3
Country or territory Cyprus Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica
1990 11 14 45 181 9 123 17 62 52 94 62 190 141 21 184 30 7 9 93 165 47 9 122 13 21 78 229 210 66 151 58 19 6 115 85 65 46 9 12 10 38
2010 3 3 26 112 3 73 11 22 18 19 14 81 42 4 68 15 2 3 54 57 20 3 50 3 9 25 81 92 25 70 20 5 2 48 27 22 31 3 4 3 20
1990 5 9 22 48 4 40 11 29 20 28 18 45 31 13 48 12 4 3 31 42 27 4 38 9 10 28 51 48 34 38 23 12 3 47 31 28 23 5 6 6 13
2010 2 2 18 46 2 34 8 15 10 9 6 35 18 3 35 8 2 2 26 31 15 2 28 2 5 15 38 40 19 27 12 4 1 32 17 14 20 2 2 2 9
13
country, regional and global estimates of under-five, infant and neonatal mortality
Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate (deaths per 1,000 live births) Number of neonatal deaths (thousands)
Under-five mortality rate (deaths per 1,000 live births) Millennium Development Average annual Goal rate of reduction targetfor (percent) 2010 2015 19902010 3 22 33 85 49 11 38 54 10 22 85 103 17 2 7 3 62 92 6 15 178 6 26 111 15 17 42 4 32 8 36 135 66 40 40 50 4 6 27 143 143 22 3 2 13 19 33 29 5 24 48 7 13 30 76 15 3 6 3 53 74 6 34 85 4 17 41 8 16 19 3 36 6 29 73 37 24 13 47 3 4 23 104 71 5 3 3.5 2.7 2.7 0.8 2.9 1.6 3.2 4.9 3.7 2.7 0.2 4.0 4.9 8.0 4.4 4.9 4.7 4.4 5.5 9.6 1.8 3.0 3.4 0.6 2.4 5.3 1.4 4.1 6.0 4.1 4.4 2.4 2.6 3.0 0.0 5.2 3.5 3.0 4.6 3.9 2.0 2.3 5.5
Country or territory Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (FederatedStates of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway
1990 6 38 57 99 87 15 72 145 21 38 89 227 45 10 17 8 159 222 18 102 255 11 51 124 24 49 56 9 107 18 86 219 112 73 40 141 8 11 68 311 213 14 9
2010 2 18 29 55 39 10 33 42 8 19 65 74 13 2 5 2 43 58 5 14 99 5 22 75 13 14 34 3 26 7 30 92 50 29 32 41 4 5 23 73 88 19 3
1990 5 4 19 63 0 1 8 17 1 2 4 14 3 0 1 0 50 55 8 1 52 0 0 6 1 91 0 0 6 0 46 81 85 3 0 69 1 1 7 53 516 0 0
2010 3 3 11 80 0 1 5 6 0 1 4 11 2 0 0 0 31 36 3 0 68 0 0 9 0 31 0 0 2 0 20 77 43 2 0 29 1 0 3 52 537 0 0
1990 3 20 26 31 29 9 30 39 12 18 36 53 22 10 4 40 44 9 37 57 7 19 42 16 17 22 5 27 11 36 51 44 25 22 54 5 4 25 48 49 7 4
2010 1 13 17 28 19 6 19 21 5 12 35 34 10 3 1 22 27 3 9 48 4 12 39 9 7 18 2 12 5 19 39 32 17 22 28 3 3 12 32 40 10 2
1990 3 3 10 30 0 0 4 7 0 1 2 5 2 1 0 20 19 5 0 24 0 0 3 0 41 0 0 2 0 26 31 47 1 0 40 1 0 4 21 211 0 0
2010 1 2 6 43 0 0 2 3 0 1 2 5 1 0 0 16 18 2 0 34 0 0 5 0 16 0 0 1 0 12 35 26 1 0 20 1 0 2 24 254 0 0
14
country, regional and global estimates of under-five, infant and neonatal mortality
Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate (deaths per 1,000 live births) Number of neonatal deaths (thousands)
Under-five mortality rate (deaths per 1,000 live births) Millennium Development Average annual Goal rate of reduction targetfor (percent) 2010 2015 19902010 22 9 87 19 20 61 25 19 29 6 4 8 5 19 14 12 91 8 16 21 20 2 80 18 75 7 14 174 3 8 3 27 180 57 5 17 103 31 78 3 5 16 63 13 15 16 41 11 11 30 17 26 20 6 5 7 3 12 12 9 54 9 8 9 9 4 31 15 46 10 6 92 3 6 3 15 60 20 4 11 42 17 32 2 3 13 39 11 3.6 8.3 1.8 2.8 2.5 1.9 3.5 7.1 3.6 5.2 6.6 4.8 2.4 3.3 4.9 4.1 2.9 6.3 1.8 1.3 1.5 9.0 0.8 4.6 3.1 7.1 1.0 2.3 4.9 4.1 6.0 2.6 0.0 0.3 3.9 3.2 1.0 2.6 1.0 4.2 2.4 4.3 3.1 4.5
Country or territory Occupied Palestinian Territory Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudana Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand
1990 3 3 431 0 2 9 5 36 85 8 1 0 4 3 12 48 32 0 0 0 0 0 0 19 21 3 0 26 0 1 0 0 33 50 4 9 80 0 3 1 0 14 20 29
2010 3 0 347 0 1 10 3 9 52 2 0 0 2 1 3 16 25 0 0 0 0 0 0 10 23 1 0 26 0 0 0 0 42 41 2 5 92 0 2 0 0 7 10 9
1990 22 51 14 14 30 24 27 23 11 7 10 3 15 15 12 41 17 13 16 10 5 28 20 40 16 9 57 4 12 5 18 52 18 6 18 39 21 24 3 4 18 37 17
2010 5 41 9 9 23 14 9 14 4 2 4 2 9 8 6 29 5 10 13 8 1 25 10 27 4 8 45 1 4 2 12 52 18 3 10 35 14 21 2 3 9 25 8
1990 2 230 0 1 4 3 18 46 6 1 0 2 1 5 25 12 0 0 0 0 0 0 12 13 2 0 10 0 1 0 0 15 20 3 6 43 0 1 0 0 8 8 18
2010 0 194 0 1 5 2 6 32 1 0 0 1 0 2 10 13 0 0 0 0 0 0 6 13 0 0 10 0 0 0 0 21 19 1 4 50 0 1 0 0 4 5 7
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country, regional and global estimates of under-five, infant and neonatal mortality
Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate (deaths per 1,000 live births) Number of neonatal deaths (thousands)
Under-five mortality rate (deaths per 1,000 live births) Millennium Development Average annual Goal rate of reduction targetfor (percent) 2010 2015 19902010 12 55 103 16 27 16 18 56 33 99 13 7 5 76 8 11 52 14 18 23 77 111 80 13 56 49 8 12 16 27 33 19 58 7 7 3 52 4 8 26 13 11 17 43 61 26 5.9 5.6 1.8 2.2 1.6 5.6 7.5 2.8 2.7 2.8 2.4 5.7 2.9 3.6 1.6 3.7 2.0 5.1 3.0 4.0 2.5 2.5 0.1
Country or territory The former Yugoslav Republic of Macedonia Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe
2010 10 46 66 13 24 14 14 47 27 63 11 6 5 50 7 9 44 12 16 19 57 69 51
1990 1 3 13 0 1 9 87 11 0 88 13 1 6 103 37 1 46 0 16 70 52 36 19
2010 0 2 12 0 0 3 19 5 0 92 6 1 4 90 28 0 27 0 9 28 52 38 19
1990 17 48 40 11 23 23 33 33 22 36 9 12 5 40 6 11 30 16 17 23 43 40 27
2010 8 24 32 8 18 9 10 23 14 26 6 4 3 26 4 6 23 7 10 12 32 30 27
1990 1 2 6 0 1 5 47 4 0 31 6 1 4 45 22 1 22 0 9 45 27 14 10
2010 0 1 6 0 0 2 13 2 0 39 3 0 2 48 18 0 13 0 6 18 29 18 10
Estimates of under-five, infant and neonatal mortality by Millennium Development Goal regionb,c
Developed regions Developing regions Northern Africa Sub-Saharan Africa Latin America & Caribbean Caucasus & Central Asia Eastern Asia Excluding China Southern Asia Excluding India South-eastern Asia Western Asia Oceania World 15 97 82 174 54 77 48 28 117 123 71 67 75 88 7 63 27 121 23 45 18 17 66 72 32 32 52 57 5 32 27 58 18 26 16 9 39 41 24 22 25 29 3.8 2.2 5.6 1.8 4.3 2.7 4.9 2.5 2.9 2.7 4.0 3.7 1.8 2.2 227 11,782 304 3,734 623 155 1,308 29 4,521 1,443 853 270 14 12,010 99 7,515 95 3,709 249 78 331 17 2,526 830 349 165 14 7,614 12 67 62 105 43 63 38 17 84 90 49 52 55 61 6 44 23 76 18 39 16 14 51 56 25 25 41 40 186 8,202 227 2,273 491 127 1,042 17 3,239 1,053 582 211 11 8,389 83 5,346 81 2,350 191 67 285 14 1,958 653 271 131 11 5,429 7 36 29 43 23 30 23 12 48 48 28 28 26 32 4 25 13 35 11 21 11 9 32 33 15 16 21 23 106 4,319 107 969 265 58 589 14 1,875 576 335 116 5 4,425 53 3,019 46 1,123 117 34 189 8 1,256 381 169 79 5 3,072
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country, regional and global estimates of under-five, infant and neonatal mortality
Estimates of under-five, infant and neonatal mortality by uniCEF regionc
Under-five mortality rate (deaths per 1,000 live births) Millennium Average Development annual rate of Goal reduction targetfor (percent) 2015 19902010 53 58 52 65 26 29 40 18 18 1.8 1.8 2.3 1.6 3.2 2.9 2.9 4.1 4.3 Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infantdeaths (thousands) Neonatal mortality rate Number of (deaths per 1,000 neonatal deaths live births) (thousands)
Region Africa Sub-Saharan Africa Eastern and Southern Africa West and Central Africa Middle East and North Africa Asia South Asia East Asia and Pacific Latin America and Caribbean Central and Eastern Europe/Commonwealth of Independent States Industrialized countries Developing countries Least developed countries World
1990 4,038 3,734 1,559 2,046 718 6,575 4,399 2,175 623
2010 3,804 3,709 1,322 2,241 415 3,186 2,492 694 249
2010 71 76 63 88 31 37 52 19 18
1990 2,500 2,273 982 1,208 526 4,781 3,147 1,634 491
2010 2,431 2,350 858 1,398 316 2,496 1,929 567 191
1990 41 43 39 47 29 37 49 25 23
2010 33 35 30 39 18 24 33 13 11
1990 1,076 969 411 514 271 2,754 1,824 930 265
2010 1,169 1,123 425 647 180 1,602 1,239 363 117
50 10 97 170 88
23 6 63 110 57
17 3 32 57 29
41 9 67 106 61
19 5 44 71 40
21 5 36 47 32
11 3 25 34 23
Estimates of under-five, infant and neonatal mortality by World Health Organization regionc
Under-five mortality rate (deaths per 1,000 live births) Millennium Average Development annual rate of Goal reduction targetfor (percent) 2015 19902010 57 14 33 11 37 16 29 1.8 4.2 1.9 4.3 3.4 4.6 2.2 Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infantdeaths (thousands) Neonatal mortality rate Number of (deaths per 1,000 neonatal deaths live births) (thousands)
Region Africa Americas Eastern Mediterranean Europe South-East Asia Western Pacific World
2010 119 18 68 14 56 19 57
1990 104 34 74 27 78 37 61
2010 75 14 51 12 44 16 40
1990 42 18 38 14 45 22 32
2010 34 9 28 7 29 11 23
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country, regional and global estimates of under-five, infant and neonatal mortality
Estimates of under-five, infant and neonatal mortality by World bank regionc
Under-five mortality rate (deaths per 1,000 live births) Millennium Average Development annual rate of Goal reduction targetfor (percent) 2015 19902010 55 28 38 16 32 19 16 18 25 40 58 4 29 2.1 2.4 2.5 4.5 2.2 4.2 3.8 4.3 4.0 2.9 1.8 3.5 2.2 Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infantdeaths (thousands) Neonatal mortality rate Number of (deaths per 1,000 neonatal deaths live births) (thousands)
Region Low income Middle income Lower middle income Upper middle income Low and middle income East Asia & Pacific Europe & Central Asia Latin America & Caribbean Middle East & North Africa South Asia Sub-Saharan Africa High income World
1990 3,194 8,656 6,327 2,330 11,850 2,171 373 622 557 4,399 3,728 155 12,010
2010 2,667 4,860 4,163 698 7,527 691 136 249 255 2,492 3,704 85 7,614
2010 70 38 50 16 44 20 19 18 27 52 76 5 40
1990 2,015 6,244 4,379 1,865 8,259 1,630 304 490 418 3,147 2,269 127 8,389
2010 1,731 3,623 3,036 588 5,355 565 114 191 210 1,929 2,346 72 5,429
1990 46 33 41 23 35 25 21 23 29 49 43 6 32
2010 33 23 29 11 25 13 11 11 16 33 35 4 23
1990 944 3,402 2,374 1,028 4,346 927 149 264 214 1,824 967 79 4,425
2010 866 2,161 1,787 374 3,027 362 65 117 123 1,239 1,121 45 3,072
Estimates of under-five, infant and neonatal mortality by united nations Population Division regionC
Under-five mortality rate (deaths per 1,000 live births) Millennium Average Development annual rate of Goal reduction targetfor (percent) 2015 19902010 5 32 57 27 37 58 53 28 6 18 4 12 29 3.8 2.2 2.2 2.6 2.3 1.8 1.8 3.0 4.7 4.3 2.3 1.7 2.2 Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infantdeaths (thousands) Neonatal mortality rate Number of (deaths per 1,000 neonatal deaths live births) (thousands)
Region More developed regions Less developed regions Least developed countries Excluding least developed countries Excluding China Sub-Saharan Africa Africa Asia Europe Latin America & Caribbean Northern America Oceania World
1990 226 11,784 3,496 8,287 10,504 3,734 4,038 7,116 168 623 47 17 12,010
2010 99 7,516 2,949 4,567 7,201 3,709 3,804 3,453 59 249 35 16 7,614
2010 6 44 71 37 49 76 71 36 6 18 6 19 40
1990 185 8,204 2,199 6,005 7,179 2,273 2,500 5,207 138 491 39 13 8,389
2010 83 5,346 1,912 3,435 5,075 2,350 2,431 2,716 49 191 30 12 5,429
1990 7 36 47 33 39 43 41 35 8 23 6 13 32
2010 4 25 34 22 27 35 33 23 4 11 4 10 23
1990 105 4,320 1,024 3,296 3,744 969 1,076 2,977 76 265 24 7 4,425
2010 53 3,019 956 2,063 2,838 1,123 1,169 1,729 31 117 20 6 3,072
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 from World Population Prospects: The 2010 Revision, published by the United Nations Department of Economic and Social Affairs. a Data refer to Sudan as it was constituted in 2010, before South Sudan seceded on 9 July 2011. b See next page for country classifications by region. c The sum of the number of deaths by region may differ from the world total because of rounding.
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Regional Classifications
The regional classifications that are referred to in the report and for which aggregate data are provided in the statistical table are Millennium Development Goal regions (see below). Aggregates presented for member organizations of the Inter-agency Group for Child Mortality Estimation may differ. Regions with the same names in different agencies may include different countries.
Developed regions
Albania, Andorra, Australia, Austria, Belarus, Belgium, 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 Macedonia, 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, Vanuatu
South-eastern Asia
Brunei Darussalam, Cambodia, Indonesia, Lao Peoples Democratic Republic, Malaysia, Myanmar, Philippines, Singapore, Thailand, Timor-Leste, VietNam
Southern Asia
Developing regions
Caucasus and Central Asia
Afghanistan, Bangladesh, Bhutan, India, Iran (Islamic Republic of), Maldives, Nepal, Pakistan, SriLanka
Sub-Saharan Africa
Antigua and Barbuda, Argentina, Bahamas, Barbados, Belize, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Kitts and Nevis, 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, Cte dIvoire, Democratic Republic of the Congo, Djibouti, Equatorial Guinea, 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, Sierra Leone, Somalia, South Africa, Sudan*, Swaziland, Togo, Uganda, United Republic of Tanzania, Zambia, Zimbabwe
Western Asia
Bahrain, Iraq, Jordan, Kuwait, Lebanon, Occupied Palestinian 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.
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On the cover photo: A malnourished child waits for a meal of rice and dal at an anganwadi centre in Sullineabad Village, 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 women in impoverished areas. Some 29 percent of children in the village suffer from severe acute malnutrition. Photo credits: cover, UNICEF/NYHQ20090908/Brian Sokol; page 2, UNICEF/NYHQ20111115/KateHolt; page 4, UNICEF/INDA201100039/Graham Crouch; page 20, UNICEF/INDA201000212/Graham Crouch.