In 2000, the world made a promise to reduce deaths among children under-five by two thirds by 2015, compared to 1990, the benchmark year for the Millennium Development Goals. With less than 500 days left until the deadline, great progress has been made, but the world still risks breaking one of the most profound promises ever made to children.
In East Asia and the Pacific, progress is evident at the regional level with very impressive reductions in child mortality compared to 1990. However, the level and breadth of success is by no means uniform, particularly when we look at the sub-national-level and disparities within countries come to light. The major killers remain pneumonia and diarrhoea, along with more pronounced numbers in the first month after birth.
New UNICEF figures published in the Committing to Child Survival: A Promise Renewed report, show that the world continues to make progress in preventing deaths among children. Since 1990, under-5 mortality has halved and in 2013 the number of under-5 deaths had fallen to 6.3 million, compared to 12.7 million in 1990. The global rate of under-five mortality is declining faster today than at any time over the past two decades, and more children are living to celebrate their fifth birthday.
But despite this progress, 17,000 children under five still die every day. That equates to one life ending every five seconds – around the length of time it took you to read this sentence. And while mortality is falling overall, many are being left behind, including the most vulnerable – newborn babies aged under 28 days.
In 2013, almost 1 million children died on the day they were born, their first and only day of life. More than two fifths of under-five deaths occurred during the neonatal period – the first 28 days of life. In 1990, by contrast, neonatal deaths contributed to only 37 per cent of the global under-five mortality.
Having worked in the region since 1996, I have witnessed first-hand the remarkable progress across the region and at country level. In Mongolia, for example, the neonatal mortality rate in 1990 was 31 for every 1,000 live births. As the latest figures reveal, this number is now down to a level of 13 in 1,000.
I have travelled across the vast steppes of Mongolia, visiting hospitals and health centres. It was very clear to me that lives were being saved and services delivered, under sometimes very challenging conditions. However, the work is not yet complete. Basic and essential equipment to save newborn lives, purchased over the years in Mongolia, is in need of maintenance and replacement. We need continued efforts to ensure the affordability, access and quality of services, and to raise public awareness.
|In Mongolia, 7-month-old Bulgansor has never been sick.
Her mother breastfed her for the first six months of her life
In the Philippines, where good progress has also been made, ending preventable deaths remains an important priority. According to the latest figures, there were approximately 71,000 deaths of under 5-year-olds in 2013, down from 119,000 in 1990. Similarly, there was a reduction in newborn deaths, from 23 in 1,000 births in 1990, to 14 in 1,000 births in 2013. However, newborn mortality has fallen more slowly – babies under 28-days-old now account for approximately 46 per cent of all under-5 deaths.
Globally, many women and children are not receiving the services they need to give birth safely and see their children survive and thrive. Experts agree that the presence of a skilled birth attendant to assist a woman in labour can lower the risk of stillbirth and neonatal death by 20 percent. Despite this, almost one third of women give birth without a skilled birth attendant, many completely alone. In 2012, an estimated 44 million newborns entered into the world without the help of a skilled birth attendant, increasing their risk and their babies’ risk of grave complications.
The good news is that we already possess the tools and the knowledge to save the majority of these lives. Simple, affordable solutions including blood tests, folic acid supplementation and immunization can effectively prevent problems from occurring before, during and after birth, substantially reducing mortality rates. Simple steps like initiating breastfeeding within one hour of birth can reduce the risk of neonatal death by 44 per cent. And by ensuring that all women, everywhere have access to a skilled birth attendant, we can dramatically cut newborn and under-five mortality.
But interventions alone are not enough – government commitment is the key which can unlock the door to child survival. In this area, too, there has been impressive progress. Around the world, 178 countries, including the Philippines, have shown bold leadership by signing the Committing to Child Survival: A Promise Renewed pledge to eliminate preventable child mortality. In April, 2014, the Philippines Government took this pledge to the next level by launching a country strategy to eliminate child mortality, under the banner of A Promise Renewed.
As the world moves rapidly towards the deadline for the Millennium Development Goals, and looks forward to the decades to come, it is crucial that maternal and child survival remain squarely on the agenda. We have the tools; we have the commitment. Now is the time for action.