Photo Credit: Moises Saman for The New York Times
Yesterday UNICEF announced new data that shows that child mortality has continued to decline globally. For the first time in a long time, the number of children who die every year has dropped to less than 9 million. Using the same data, which is based on a new estimation method, UNICEF estimates that in 1990 – the starting time period for the Millennium Development Goals – 12.5 million children died every year. They estimate that the we have seen a 28% decline in the child mortality rate in roughly 18 years, or about 1.8% a year. This, I think, is a notable achievement. But of course, it is no where near the levels required to achieve MDG4 (a two-thirds reduction in child mortality).
So what should we make of this announcement? I think most people would probably say that this is good news, which I do think it is. But of course, we could also think of this as big disappointment: we are not going to meet the MDG4.
My initial thought after reading Celia Dugger’s piece yesterday in the NYTimes was to be suspicious. The announcement was that there has been a decline in the number – or level – of child deaths, which I thought was an unusual metric to report. The number of deaths is a function of the number of women, the number of births per woman, and proportion of children that die. When I think child mortality, I think just the last of these components. Fertility has been on the decline and it could very well be that we now have less deaths because there are just less births. But as it turns out, this is not what happened because of a nifty little phenomenon that demographers like to call “population momentum“. Since there are more women alive, we still have more births even with lower fertility. We have actually seen a nearly proportional decline in the actual under 5 mortality rate (deaths per live birth). Reporting numbers was probably just to make sense to the general public.
The declines, however, have not been evenly distributed over time, nor have they be equally distributed around the world. Sub-Saharan Africa was the region with the highest child mortality rates saw the least declines, whereas the regions with the lowest child mortality rates saw the highest proportional declines, which is the exact opposite of what you would want and what we would expect if we want to give a lot of credit to these declines to the collective action from the international community to target child death in the poorest countries.
But there appears to be an acceleration of the mortality declines since 2000, which does support a story that stepped up efforts are working. During the 1990s, the average annual rate of decline was 1.4% globally, and it increased to 2.3% during the 2000s.
So what explains the declines? There is next to no mention of it in the UNICEF release, nor is the data yet available for me to try to figure this out. But in the Dugger article she argues:
The child mortality rate has declined by more than a quarter in the last two decades — to 65 per 1,000 live births last year from 90 in 1990 — in large part because of the widening distribution of relatively inexpensive technologies, like measles vaccines and anti-malaria mosquito nets.
Perhaps. I certainly buy the measles story – my guess is that measles vaccination alone might be responsible for half a million fewer deaths a year since the early 1990s, if not more. However, because the data used is based on data collected over a 3-5 year time period, UNICEF cautions against attributing too much of these declines to relatively new interventions that have only taken off during the last few years, which is where I would include malaria efforts. I suspect the declines have had more to do with expanded coverage of additional vaccines, improvements in nutrition and sanitation, and likely to an increase proportion of births that are supervised and take place in facilities, in particular in Asia (neonatal mortality is the biggest cause of death).
So how do we ensure continued progress? As I have argued recently, I do not think real progress can be made without specifically addressing some of the major killers of children, specifically neonatal mortality, pneumonia, and diarrhea. I worry, however, that these concerns are currently being overshadowed by other health concerns. As the following graph shows, even if we did completely wide out malaria and HIV, we would hardly make a dent in child mortality globally. This is not to say that I don’t think that addressing these issues is important – I think it is crucial – I just hope we give more attention to some of these other concerns. Vaccines are coming online for pneumonia and diarrhea, but neonatal mortality is less likely to be addressed in any big way – and needs to be.Share on Facebook