NEW YORK/GENEVA/WASHINGTON D.C., 10 January 2023 – An estimated 5 million children died before their fifth birthday and another 2.1 million children and youth aged between 5–24 years lost their lives in 2021, according to the latest estimates released by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME).

In a separate report also released today, the group found that 1.9 million babies were stillborn during the same period. Tragically, many of these deaths could have been prevented with equitable access and high-quality maternal, newborn, adolescent and child health care.

“Every day, far too many parents are facing the trauma of losing their children, sometimes even before their first breath,” said Vidhya Ganesh, UNICEF Director of the Division of Data Analytics, Planning and Monitoring. “Such widespread, preventable tragedy should never be accepted as inevitable. Progress is possible with stronger political will and targeted investment in equitable access to primary health care for every woman and child.”

The reports show some positive outcomes with a lower risk of death across all ages globally since 2000. The global under-five mortality rate fell by 50 per cent since the start of the century, while mortality rates in older children and youth dropped by 36 per cent, and the stillbirth rate decreased by 35 per cent. This can be attributed to more investments in strengthening primary health systems to benefit women, children and young people.

However, gains have reduced significantly since 2010, and 54 countries -three of them from Latin America and the Caribbean- will fall short of meeting the Sustainable Development Goals target for under-five mortality. If swift action is not taken to improve health services, warn the agencies, almost 59 million children and youth will die before 2030, and nearly 16 million babies will be lost to stillbirth.

“It is grossly unjust that a child’s chances of survival can be shaped just by their place of birth, and that there are such vast inequities in their access to lifesaving health services,” said Dr Anshu Banerjee, Director for Maternal, Newborn, Child and Adolescent Health and Ageing at the World Health Organization (WHO). “Children everywhere need strong primary health care systems that meet their needs and those of their families, so that – no matter where they are born – they have the best start and hope for the future.”

Children continue to face wildly differentiating chances of survival based on where they are born, with sub-Saharan Africa and Southern Asia shouldering the heaviest burden, the reports show.

In Latin America and the Caribbean, mortality in children under the age of five fell by 50% between 2000 and 2020 and mortality rates in older children and youth dropped by 18%.

However, there remains significant disparities in mortality rates among and within countries of the Americas: in some countries, including Cuba and Uruguay, the mortality rate for under-fives is 5 and 6 deaths per 1,000 live births, respectively, in the Dominican Republic and Haiti, the rate increases to 34 and 60 deaths per 1,000 live births, respectively.

Many of these deaths are due to congenital malformations and complications of being born early. As they grow older, violence, road injuries, suicide, are some of the primary causes of death. Most deaths are preventable. Expanding primary health care, strengthening health systems and aligning strategies and funding across sectors and stakeholders, are key to reducing child, adolescents and youth mortality in the Region.

Access to and availability of quality health care continues to be a matter of life or death for children globally. Most child deaths occur in the first five years, of which half are within the very first month of life. For these youngest babies, premature birth and complications during labor are the leading causes of death. Similarly, more than 40 per cent of stillbirths occur during labor – most of which are preventable when women have access to quality care throughout pregnancy and birth. For children that survive past their first 28 days, infectious diseases like pneumonia, diarrhea and malaria pose the biggest threat.

While COVID-19 has not directly increased childhood mortality – with children facing a lower likelihood of dying from the disease than adults – the pandemic may have increased future risks to their survival. In particular, the reports highlight concerns around disruptions to vaccination campaigns, nutrition services, and access to primary health care, which could jeopardize their health and well-being for many years to come. In addition, the pandemic has fueled the largest continued backslide in vaccinations in three decades, putting the most vulnerable newborns and children at greater risk of dying from preventable diseases.

The reports also note gaps in data, which could critically undermine the impact of policies and programs designed to improve childhood survival and well-being.

  Caribbean, children, Latin America, PAHO