The death toll for under-fives was 4.8 million in 2023 – a significant decline – with stillbirths falling marginally to around 1.9 million, data released by the UN shows.
Despite this, decades of hard-won progress in child survival is under threat as a result of funding cuts, health system challenges and regional disparities, UNICEF and the World Health Organization (WHO) are warning alongside members of the interagency network IGME.
“Millions of children are alive today because of the global commitment to proven interventions, such as vaccines, nutrition, and access to safe water and basic sanitation,” said Catherine Russell, UNICEF Executive Director.
“Bringing preventable child deaths to a record low is a remarkable achievement. But without the right policy choices and adequate investment, we risk reversing these hard-earned gains, with millions more children dying from preventable causes. We cannot allow that to happen,” she emphasised.
Preventable causes of child deaths
The data – contained in two reports – also showed that almost half of under-five deaths occurred within the first month of life, predominantly due to premature birth and complications during labour.
For those who survived past infancy, infectious diseases – such as pneumonia, malaria, and diarrhoea – remained leading causes of preventable death.
In addition, almost half of late stillbirths occur during labour, often due to maternal infections, prolonged or obstructed labour and lack of timely medical intervention.
Experts stressed that improving access to high-quality maternal, newborn and child health care is critical to preventing these deaths.
Regional disparities
Where a child is born greatly influences their chances of survival. In low-income countries, essential services, vaccines and treatments are often inaccessible, contributing to disproportionately high mortality rates.
The risk of death before turning five is 80 times higher in the highest-mortality country than the lowest-mortality country, the reports found. Within countries, the poorest children, those living in rural areas and those with less-educated mothers faced higher risks.
Stillbirths followed similar patterns, with women in low-income countries eight times more likely to experience a stillbirth than those in high-income countries.
Under-five mortality rate.
Regional estimates
Sub-Saharan Africa recorded the highest estimated under-five mortality rate, with 69 deaths per 1,000 live births, while the overall estimate for Africa stood at 63 per 1,000.
In contrast, estimated under-five mortality rates were significantly lower in Europe (4) and Northern America (6). Asia was estimated at 26 deaths, while Latin America and the Caribbean stood at 16, and Oceania at 19.
A similar disparity existed in estimated stillbirth rates. Sub-Saharan Africa had the highest estimate at 22.2 stillbirths per 1,000 births, compared to 2.7 in Northern America and 2.9 in Europe.
Asia was estimated at 12.3 per 1,000, Latin America and the Caribbean at 7.4, and Oceania at 9.5. For Africa as a whole, the estimated stillbirth rate stood at 21 per 1,000 births.
Funding cuts
Cuts in funding for lifesaving child survival programmes are worsening existing disparities.
Reduction in resources have led to healthcare worker shortages, clinic closures, disruptions in vaccination campaigns and shortages of essential supplies such as malaria treatments.
Countries affected by humanitarian crises, those with significant debt burdens or already facing high child mortality rates are particularly impacted.
Call to action
Tedros Adhanom Ghebreyesus, WHO Director-General, underscored the need to urgently scale up collaboration to protect children’s lives and their health.
“From tackling malaria to preventing stillbirths and ensuring evidence-based care for the tiniest babies, we can make a difference for millions of families,” he said.
