Progress in child survival worldwide has been described
as one of the greatest success stories of international
development, with child deaths being almost halved over
the last two decades compared to the 1990 MDG baseline.
Between 1990 and 2013 under-five mortality rates
declined by 49%, falling from an estimated 90 deaths
per 1000 live births to 46 deaths per 1000 live births.
More than half of this reduction has taken place in the
past decade with the global rate of decline accelerating
greatly – from 1.2% per annum between 1990 and 1995
to 4.0% per annum between 2005 and 2013. As a result,
an estimated 17000 fewer children died every day in
2013 than in 1990. Nevertheless, such a rate of decline
remains insufficient to reach the target of a two thirds
reduction in the 1990 mortality levels by the year 2015.
Worldwide, the total number of neonatal deaths decreased
from 4.7 million in 1990 to 2.8 million in 2013.
Neonatal mortality rates per 1000 live births declined
from 33 to 20 over the same period – a reduction of
39%. This rate of decline is slower than that for child
mortality overall with the proportion of deaths in children
aged < 5 years that occurred in the neonatal period
increasing from 37% in 1990 to 44% in 2013.
Despite remarkable progress at the global level, the MDG
Target 4.A will not be achieved in most countries by
2015. Table 2 shows the number of countries that: (a)
have achieved this target; (b) are on track to meet the target
by 2015 if the current rate of progress is maintained;
(c) are at least halfway to achieving a two thirds reduction
in the 1990 level of mortality but are unlikely to achieve it
by 2015 at the current rate of progress; and (d) are less
than halfway to meeting the target. As shown in Table 2,
less than one third of all countries have either achieved
or are on track to meet the MDG target by 2015.
Improved understanding of cause-specific trends will
now be an essential element in accelerating further change.