Reducing child mortality

Child mortality refers to the probability of dying between birth and age 5, expressed per 1,000 live births. The term under-five mortality is also used.

This strategy features in the framework of Agenda 21 as formulated at UNCED (Rio de Janeiro, 1992), now coordinated by the United Nations Commission on Sustainable Development and implemented through national and local authorities.

The reduction of infant and child mortality is expected to remain the first priority concern of most individual UNICEF country programmes. Support for accelerating immunization and oral rehydration therapy (ORT) remains an essential element of these programmes. Although it remains difficult to estimate the number of infant and child lives saved as a result of the actions advocated by UNICEF since the early 1980s, WHO estimates that the deaths of between 750,000 and 1 million children under five years of age are already being averted each year owing to the increase of such therapy and that at least 1.5 million deaths were averted during 1988 through a programme of universal child immunization (UCI). It has been estimated that through ORT, water and sanitation and other health and nutrition measures undertaken by UN agencies, child mortality rates in the developing countries have been halved since 1960, increasing the average life expectancy from 37 to 67 years.

Advances in income and education have allowed households almost everywhere in the world to improve their health. In the 1980s, even in countries in which average incomes fell, death rates of children under age 5 declined by almost 30%. But the child mortality rate fell more than twice as much in countries in which average incomes rose by more than 1% a year.

BASICS (Basic Support for Institutionalizing Child Survival) provides both technical leadership and practical field programs for reducing infant and childhood illness and death worldwide. The project operates programs in Africa, Asia, Latin America, and in the New Independent States (NIS). BASICS provides these countries with cost-effective child survival interventions and serves as a technical resource to those around the globe who design and implement child survival health programs. The project also collaborates with a wide range of nongovernmental organizations, other donors, and public health institutions in the following six programmatic areas: (1) sustaining immunization programs; (2) integrating effective case management of childhood illnesses; (3) strengthening the link between nutrition and health; (4) promoting techniques for monitoring and evaluation; (5) improving techniques for monitoring and evaluation; (6) establishing public/private partnerships.

The vicious cycle of high infant, child and maternal mortality on the one hand, and of high fertility on the other, continues to pervade a large number of developing countries. It is estimated that 14 million children below the age of five die each year, 95% of them in developing countries. Similarly, about 500,000 women die unnecessarily each year because of complications relating to pregnancy and child birth. Most of these deaths could be avoided through simple, effective and inexpensive measures. Infant and child mortality can be reduced dramatically through breast-feeding, adequate nutrition, safe water, health and population education, immunization programmes, oral rehydration therapy and birth spacing. Similarly, maternal mortality can be reduced substantially through maternal health care, birth spacing, maternal education and fertility limitation. Given the reciprocal benefits such practices confer on both mothers and children, the net impact of reductions in infant, child and maternal mortality will improve human welfare. It is thus imperative that population programmes pursue goals related not only to levels of population growth and/or fertility, but also include goals to reduce mortality, especially that of mothers and children. Therefore, the achievement of an infant mortality rate of 50 per 1000 live births, especially in those countries where infant mortality is high, as well as the reduction of maternal mortality by at least 50% by the year 2000 (especially in countries where the rate is higher than 100 maternal deaths per 100,000 births) should be a primary goal in the 1990s.