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Reduce by two thirds, between 1990 
and 2015, the under-five mortality rate.
 
 
 
Rapid improvements before 1990 gave hope that mortality rates for infants and children under five could be cut by two-thirds in the following 25 years. But progress slowed almost everywhere in the 1990s. 
 
Every year almost 11 million children in developing countries still die before the age of five. Most die from causes that are readily preventable in rich countries: acute respiratory infections, diarrhea, measles, and malaria.
 
Only two regions, Latin America and the Caribbean and Europe and Central Asia, are close to achieving the target on average. But even there, more than half the countries are off track. Progress has been particularly slow in Sub-Saharan Africa, where civil disturbances and the HIV/AIDS epidemic have driven up rates of infant and child mortality. By the most recent data available, only 35 countries are making enough progress to reduce under-five mortality rates to one-third of their 1990 level by 2015.
 
 Improving the odds for children
 Under-five mortality rate (deaths per 1,000 children)
  Sub-Saharan Africa   South Asia
   
 
The gap between goal and reality is greatest in Sub-Saharan Africa, but millions of children are also at risk in populous South Asia.
 
  East Asia & Pacific   Latin America & Caribbean
   
 
The pace of mortality reduction in East Asia and Pacific is slowing. The regional average in Latin America and the Caribbean disguises wide variations.
 
  Europe & Central Asia   Middle East & North Africa
   
 
In Europe and Central Asia questions remain about the quality and comparability of data over time. More than half the countries in the Middle East and North Africa are on track to reach the target.
 

Source: World Bank staff estimates.

       
 

    
 Country by country progress toward reduced child mortality
 Share of countries on track to achieve the child mortality target (%)
    

Source: World Bank staff estimates.
     

    

       

A concerted effort to improve the measurement of infant and child mortality has filled many gaps in the international data set, revealing that many countries still fall short of achieving the target, even where regional averages have been improving. Based on estimates through 2004, only 35 countries are on track to achieve a two-thirds reduction in mortality rates. Every country in Sub-Saharan Africa is off track, and in some countries mortality rates have increased since 1990. The good news is that recent surveys have found rapidly falling mortality rates. These could be the first signs of faster progress.
 
 
    
 Prevention comes first
 Measles immunization rate (% of children ages 12–23 months)
    

a. Data are for 1992 and 2004.
 

Source: World Health organization and United Nations Children’s Fund estimates.
     
Many causes of early childhood deaths are preventable through the basic elements of public health: immunization programs, hand washing, access to safe water and sanitation facilities, and good nutrition. Measles immunization now reaches more infants, and measles deaths are falling. Developing regions with more than 90 percent immunization rates are on par with the high-income economies.
 

    
 Cruel differences
 Under-five mortality and immunization rates by wealth quintiles
Mali
Mortality rate (per 1,000 children), 2000
 

Child mortality rates in Mali are high even for comparatively wealthy families.

      
         
        South Africa
Mortality rate (per 1,000 children), 1998
 

In South Africa the disparity between rich and poor is greater, but the average is much lower than in Mali.

    
         
        Mali
Immunization rate, 2000 (%)
 

Mali has low immunization rates, especially for its poorest children. Diphtheria, pertussis, and tetanus (DPT) immunization, which is harder to deliver, lags behind measles for all income groups.

    
         
        South Africa
Immunization rate, 1998 (%)
 

In South Africa immunization programs reach most children in all income groups, and DPT immunization rates are almost equal to those for measles immunization.

    
         

Source: World Bank staff estimates based on Demographic and Health Surveys.
 
 

         
 Text figures & Boxes
Improving the odds for children  
 
Sub-Saharan Africa
South Asia
East Asia & Pacific
Latin America & Caribbean
Europe & Central Asia
Middle East & North Africa
   
Country by country progress toward reduced child mortality

               

Prevention comes first

           
Cruel differences
 
Mali
Mortality rate (per 1,000 children), 2000
South Africa
Mortality rate (per 1,000 children), 1998
Mali
Immunization rate, 2000 (%)
South Africa
Immunization rate, 1998 (%)