Child survival
The world made remarkable progress in child survival in the past three decades, and millions of children have better survival chances than in 1990—1 in 27 children died before reaching age five in 2023, compared to 1 in 11 in 1990. However, progress in reducing under-five mortality has slowed in the first half of the SDG era (2015–2023) compared to what was achieved in the MDG era (2000–2015). Globally, the annual rate of reduction in under-five mortality decreased from 3.7 per cent in 2000–2015 to 2.2 per cent in 2015–2023.
Under-five mortality
The under-five mortality rate refers to the probability a newborn would die before reaching exactly 5 years of age, expressed per 1,000 live births. In 2023, 4.8 million children under 5 years of age died. This translates to 13,100 children under the age of 5 dying every day in 2023. Globally, infectious diseases, including pneumonia, diarrhoea and malaria, remain a leading cause of under-five deaths, along with preterm birth and intrapartum-related complications.
The global under-five mortality rate declined by 61 per cent, from 94 deaths per 1,000 live births in 1990 to 37 in 2023. Despite this considerable progress, improving child survival remains a matter of urgent concern. In 2023 alone, roughly 13,100 under-five deaths occurred every day, an intolerably high number of largely preventable child deaths.
Most regions in the world and 158 out of 200 countries at least halved their under-five mortality rate since 1990. Among all countries, 48 per cent (95) cut their under-five mortality by at least two-thirds over this same period – 39 of them are low- or lower-middle-income countries, indicating that, while the burden of child mortality is unevenly distributed throughout the world, improving child survival is possible even in resource-constrained settings.
Children continue to face widespread regional and income disparities in their chances of survival. Sub-Saharan Africa continues to be the region with the highest under-five mortality rate in the world—68 deaths per 1,000 live births. In 2023, 1 in 15 children in Sub-Saharan Africa died before reaching their fifth birthday—14 times higher than the risk for children born in high-income countries and almost 20 years behind the world average, which achieved a 1 in 15 rate by 2004. Disparities in child survival abound at the country level as well, where the risk of dying before age five for a child born in the highest mortality country is about 80 times higher than in the lowest mortality country, and all four countries with mortality rates above 100 deaths per 1,000 live births are in Sub-Saharan Africa.
With shifting demographics, the burden of child deaths is heaviest in Sub-Saharan Africa. Approximately 84 per cent of all under-five deaths in the world in 2023 occurred in just two regions: Sub-Saharan Africa (58 per cent) and South Asia (26 per cent). Due to growing child populations and a shift of the population distribution towards high-mortality regions, the share of global under-five deaths that occurred in Sub-Saharan Africa increased from 31 per cent in 1990 to 58 per cent in 2023 and is expected to increase even further in the next few decades.
Ending preventable child deaths worldwide will require targeted interventions to the age-specific causes of death among children. Despite strong advances in fighting childhood illnesses, infectious diseases, which disproportionately affect children in poorer settings, remain highly prevalent, particularly in Sub-Saharan Africa. Globally, infectious diseases, including pneumonia, diarrhoea and malaria, remain a leading cause of under-five deaths, along with preterm birth and intrapartum-related complications. Moreover, malnourished children, particularly those suffering from severe acute malnutrition, are at a higher risk of death from these common childhood illnesses. Access to life-saving interventions is critical to ensuring steady mortality declines in low- and middle-income countries.
Under-five mortality by wealth quintile and administrative level
While the absolute gap between the richest and the poorest narrowed in most countries since 1990, the relative gap persisted or increased in many countries. Children living in poorer households continue having a higher chance of dying than in the richest households. In 2023, under-five mortality rate among the children in the poorest households ranged from 3 per 1,000 live births to 139 per 1,000 live births, while those in the richest ranged from 2 to 94. Countries with the highest absolute gap between the richest and the poorest under-five mortality rate in 2023: Nigeria (86), Mali (65), Guinea (63). Progress in reducing under-five mortality is also uneven by wealth quintile. In Nigeria, under-five mortality rate in the richest households fell by 56 per cent from 1990 to 2023, while the poorest mortality rate declined by 45 per cent.
Explore data visualizations of under-five mortality rate estimates by wealth quintile
Despite national progress in reducing under-five mortality, subnational regional progress is uneven. In Nigeria, where the national under-five mortality rate for 2021 was 107 deaths per 1,000 live births, rates at administrative level 1 ranged from a low of 52 deaths per 1,000 live births to a high of 253 deaths per 1,000 live births in 2021. In Burundi, the national under-five mortality rate has declined by 61 per cent since 2000, while the per cent decline within administrative level 2 divisions ranged from a high of 80 per cent to a low of 56 per cent.
