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Uneven gains in child health

Table of Contents Introduction Mothers and children matter - so does their health The early years of maternal and child health Where we are now: a moral and political imperative Mothers, children and the Millennium Development Goals Uneven gains in child health The newborn deaths that went unnoticed Few signs of improvement in maternal health A patchwork of progress, stagnation and reversal The numbers remain high

Being healthy means much more than merely surviving. Nevertheless, the mortality rates of children under five years of age provide a good indicator of the progress made - or the tragic lack of it. Under-five mortality rates fell worldwide throughout the latter part of the 20th century: from 146 per 1000 in 1970 to 79 per 1000 in 2003. Since 1990, this rate has dropped by about 15%, equating to more than two million lives saved in 2003 alone. Towards the turn of the millennium, however, the overall downward trend was showing signs of slowing. Between 1970 and 1990, the under-five mortality rate dropped by 20% every decade; between 1990 and 2000 it dropped by only 12% (see Figure 1.1).

The global averages also hide important regional differences. The slowing down of progress started in the 1980s in the WHO African and Western Pacific Regions, and during the 1990s in the Eastern Mediterranean Region. The African Region started out at the highest levels, saw the smallest reductions (around 5% by decade between 1980 and 2000) and the most marked slowing down. In contrast, progress continued or accelerated in the WHO Region of the Americas, and the South-East Asia and European Regions.

The result is that the differences between regions are growing. The under-five mortality rate is now seven times higher in the African Region than in the European Region; the rate was “only” 4.3 times higher in 1980 and 5.4 times higher in 1990. Child deaths are increasingly concentrated in the African Region (43% of the global total in 2003, up from 30% in 1990). As 28% of child deaths still occur in South-East Asia, two of the six WHO regions - Africa and South-East Asia - account for more than 70% of all child deaths. Looking at it another way, more than 50% of all child deaths are concentrated in just six countries: China, the Democratic Republic of the Congo, Ethiopia, India, Nigeria and Pakistan.

The fortunes of the world’s children have also been mixed in terms of their nutritional status. Overall, children today are better nourished: between 1990 and 2000 the global prevalence of stunting and underweight declined by 20% and 18%, respectively. Nevertheless, children across southern and central Asia continue to suffer very high levels of malnutrition, and throughout sub-Saharan Africa the numbers of children who are stunted and underweight increased in this period ( ⁵² ).

Footnote

⁵² de Onis M, Blossner M. The World Health Organization Global Database on Child Growth and Malnutrition: methodology and applications. International Journal of Epidemiology, 2003, 32:518-526.

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