Babies are immunized at a health clinic in Lubango, in southern Angola. Despite Angola's vast oil wealth, the country still has one of the lowest life expectancies in the world, and one of the highest rates of child mortality.Geoffrey York/The Globe and Mail
It's one of the most dramatic achievements in the global battle against poverty so far. And it means that four million children are alive every year who would otherwise be dead.
The world's child mortality rate has dropped by a third since 1990, with the improvement accelerating in the past decade, the United Nations reported on Friday. The reasons are remarkably simple: more immunizations, more breastfeeding, more vitamin A, safer drinking water and better education.
Yet because those factors are so widely understood, the UN was aiming for much greater progress by now. Instead, as it prepares for a summit of world leaders on its millennium goals next week, the UN is admitting that it won't reach its target of cutting child mortality by two-thirds from 1990 to 2015, despite the substantial progress.
"The good news is that these estimates suggest 12,000 fewer children are dying each day around the world compared to 1990," said the UN children's fund, Unicef, in a statement on Friday.
"However, the tragedy of preventable child deaths continues," it said. "Some 22,000 children under five still die each day, with some 70 per cent of these deaths occurring in the first year of the child's life."
The worst rates of child mortality are in sub-Saharan Africa, where one in eight children die before their fifth birthday - mostly because of malaria, pneumonia and diarrhea, usually linked to malnutrition. That's nearly 20 times worse than the child mortality rate in the developed world, the UN says. Of the 31 countries with the highest rates of child mortality, 30 are in Africa.
The countries with the largest numbers of child deaths are well known. Nearly a third of all child deaths are occurring in just two countries: India and Nigeria. If the list is expanded to Pakistan, China and Congo, this group accounts for about half of all child deaths in the world.
The solutions can be relatively cheap. Some of the world's poorest countries have made dramatic improvements in their child mortality rates with simple programs. Malawi, for example, reduced its child mortality rate by 55 per cent by focusing on its poorest families, even in remote rural regions, according to an article published on Friday in The Lancet, the British medical journal. Thousands of health workers were given three months of training and then given bicycles to travel from village to village, providing vaccinations and mosquito nets to poor families, diagnosing illnesses and distributing medicine.
"A common feature of countries that have made the most substantial progress, especially in sub-Saharan Africa, has been rapid expansion of basic public health and nutrition interventions, such as immunization, breastfeeding, vitamin A supplementation and safe drinking water," said another article in The Lancet on Friday.
Meanwhile, a separate study has found an underlying cause for much of the progress: the education level of the mother. It concluded that an improvement in women's education is responsible for about half of the reduction in child mortality since 1970.
Better-educated women are more likely to obtain mosquito nets and vaccinations for their children, and more likely to use clinics and pay attention to sanitation and drinking water. "The effect of educational expansion on child health has been enormous," said the study by the Institute for Health Metrics and Evaluation at the University of Washington.
It estimated that the world has avoided 4.2 million child deaths since 1970 because of the improved education of women. And it cited other studies suggesting that the child mortality rate dropped by 7 to 9 per cent for each one-year improvement in the mother's education.