Under-five mortality rate (UFMR) reflects the socioeconomic, health, and environmental conditions in

which a child lives and develops (United Nations, 2020). It is defined as the probability of a child dying
before attaining the exact age of 5 years, calculated per 1000 live births. Globally, UFMR has declined
from 91 per 1000 live births in 1990 to 43 in 2015, which corresponds to a 52.7% reduction ( United
Nations, 2020). However, the world could not achieve the Millennium Development Goal (MDG) 4 of
reducing UFMR by two-thirds in 2015 than in 1990 ( United Nations, 2020). In 2015, more than 80% of the
total 5.9 million under-five deaths was estimated to have occurred mostly from preventable causes in
developing countries (United Nations, 2020). Under-five mortality rate as a socioeconomic and health
barometer has thus been included in the Sustainable Development Goals (SDGs) with a renewed target
of reducing the overall global mortality rate to less than 25 per 1000 live births by 2030 ( United Nations,
2021). High child mortality is indicative of low levels of socioeconomic development (Anderson et al
2002). It has economic and social costs and countries lose a significant part of GDP due to child mortality
(Bloom and Williamson 1998). In the social and demographic context, child mortality affects family
structure and birth rate. It also increases fertility (Eckstein et al 1999).
Risk factors of under-five mortality

Maternal age, Poor gestational weight gain, Maternal malnutrition, Marriage age, Poor education level,
Wealth index, Insufficient food intake, lack of health facility are key contributors for child mortality in
Bangladesh (Khan and Awan, 2017). Mother age is one of the vital factors for gestational risk and child
mortality. Adolescent and older age (>45) pregnancy are dangerous for both the child and mother.
Giving of births in adolescent period have reduced globally since 1990 but remain young age (11-19)
fertility contributes 11% of the births and 95% of these births occur in low and middle-income countries
(Ribeiro et al., 2014). Most important issue for mother is providing the quality of care by mother to her
child. For employed mother has tough responsibility especially for take care of the health outcomes of
under-five age children. In India, mortality rate for children under age of five is higher for the working
mother. Mothers working for long hours influence the children’s nutritional status and management of
adequate care (Nair et al., 2024). Parental education plays vital role to develop the health status of
children. Maternal education contributes to fertility and economic wellbeing. Beside the formal
education level, improving reading skills are also very much useful for mother and child survival (10).

Child mortality differing by sex is a vital issue to consider, under-five mortality differing with sex vary
from country to country. In developing countries, such as India and China, boys have lower under five
mortality rates in comparison to girls (Pandey , 1998). Unintended pregnancy influences the mother
health status. Mother with unintended pregnancies has less intake of folic acid from the dose of
recommended, prenatal/post-partum smoking and depression. Children born by unintended
pregnancies are at greater risk of receiving poor antenatal care in developing nations (Silverman et al.,
2007). Unintended pregnancy is prevented by using contraceptives which contribute to reduce maternal
and child mortality. According to demographic and Health Survey in Bangladesh, use of contraceptives
contribute to reduce infant mortality of birth order 2 and higher by 7.9%. In Bangladesh, complete use
of contraceptive methods contributes to decrease the child mortality with a birth order of two or higher.
Similarly, in Afghanistan higher contraceptive methods are used which is one of the key factors for
reduction in child mortality (Saha and van Soest, 2013). Smoking tobacco cigarette is very familiar sight
though non-smoking tobacco products are highly used in developing countries. Passive smoking also
caused affects to non-smokers indirectly and about 28% of child mortality occur globally (WHO, 2014).