Global efforts to end preventable child deaths have saved tens of millions of lives since the Millennium Development Goals (MDGs) were set, but this progress masks major inequalities within countries
Structurally disadvantaged social, economic, or ethnic groups of children are being left behind their better-off peers in more than three-quarters of developing countries
Policies which achieve equitable reductions in child mortality across all groups are associated with 6% faster progress in improving overall national child survival rates
Despite historic global progress in reducing under-five child mortality rates over the past 15 years, new research conducted by Save the Children has found that large groups of children are still being left behind, simply because of where they live and the circumstances in which they are born.
Many factors, including whether a child lives in a rural area or belongs to a disadvantaged ethnic group, play a huge role in a child’s chances of survival. Save the Children describes this situation as a ‘lottery of birth’.
The Lottery of Birth report, based on inaugural analysis of disaggregated data from 87 low and middle income countries around the world, reveals that in more than three quarters of these countries inequalities in child survival rates are actually worsening, resulting in some groups of children making far slower progress than their better-off peers.
In 78% of the countries covered in the report, at least one social or economic group has fallen behind and is therefore making slower progress in reducing child mortality
In 16% of the countries covered in the report, inequalities in child survival rates have increased across all social and economic groups
Save the Children’s analysis suggests that, without a true step change in action, the lottery of birth will continue into the future, slowing progress towards the ultimate goal of ending preventable child deaths for generations to come.
However, tackling this inequality is possible. Indeed, almost a fifth of the countries in the report, including Rwanda, Malawi, Mexico, and Bangladesh, have successfully combined rapid and inclusive reductions in child mortality, achieving faster progress than most countries, while at the same time ensuring that no groups of children are left behind.
The agency calls for the international community to commit to ending preventable child deaths by 2030.
The new development framework, which will replace the MDGs, will be agreed upon at the United Nations General Assembly in September 2015. This framework must set out ambitious child and maternal survival targets and commit to working towards universal health coverage.
It should also include targets to ensure that even the poorest, most marginalised and disadvantaged groups of children are included in global race to improve under-five child survival by 2030.
‘In this day and age, it is scandalous that so many children’s chances of survival across the world is purely a matter of whether or not they were lucky enough to be born into an affluent family who can access quality healthcare,’ says Jonathan Glennie, director of policy and research at Save the Children.
‘We know that change is possible. We now have a significant window of opportunity to drive this change; world leaders must do everything in their power to ensure that they grasp this opportunity with both hands.’
Some country illustrations:
In Niger, a child born in the sub-national region with the highest mortality rate in 2012 was nearly five times more likely to die before their fifth birthday than in the region with the lowest rate. This inequality has doubled since 1998.
In Indonesia a child born into the poorest 40% of households in 2012 was nearly 2.5 times more likely to die than a child in the richest 10%. This inequality has grown double since 2002.
In Honduras, in 2012, a child born in Islas de Bahia region was 3.5 times more likely to die than a child born in the most advantaged regions in the country. This inequality has increased considerably since 2006.
In Vietnam children born into the Kinh ethnic group in 2010 were 3.5 times less likely to die than their non-Kinh peers.
Other key Lottery of Birth findings include:
Disadvantaged ethnic groups and regions are most likely to be left behind; regional disparities in child mortality rates increased in 59% of the countries, while disparities between ethnic groups in 76%.
More positively, 17,000 fewer children now die every day than they did in 1990, and the global under-five child mortality rate nearly halved from 90 to 46 deaths per 1000 live births between 1990 and 2013.
About a fifth of countries have achieved above median reductions in child mortality over the past decade, while at the same time ensuring that no particular groups of children are left behind.
Notes for Editors
The background research in this report is based on new data produced, or compiled into, the Groups and Inequality Database (GRID), developed by Save the Children in collaboration with the Overseas Development Institute. It is based on direct data processing of 257 Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), aggregated public sources (the UN Inter-Agency Group for Child Mortality Estimation, WHO, UNICEF, DHS), and official disaggregated figures for a few countries without survey data. It contains 87 developing countries with disaggregated data on disparities across social and economic groups, and a total of 64 countries with data over time for up to seven data points (170 periods).