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Though the number of children who die before age 5 has declined significantly in the last two decades, the path to ending child mortality is long and hard to navigate. Nearly 7 million young children still die yearly, largely from preventable causes. What works and what doesn’t in the fight against child mortality? What will it take to go the last mile, and end preventable child deaths?  

On the road to zero: Ending preventable child deaths

A new campaign to end preventable child deaths has reenergized the global health community, but will it be enough?

WASHINGTON – On a June morning in 2012, international power brokers, doctors, and at least one Hollywood movie star came together at Georgetown University to make a promise to children around the world. 

Their vow: to double-down on efforts to save the millions of children who die each year before age 5 from preventable causes such as pneumonia, diarrhea, and malaria. In doing so, the participants at the gathering kicked off a global campaign called “A Promise Renewed” to accelerate reductions in child mortality across the globe. Key to the effort is that the countries with the most child deaths tackle the problem head on.

More than a year later, as lawmakers in Washington draw out budget debates that threaten global health spending, experts on child mortality fear that without improved coordination and sustained financial backing, the effort could fall short of its goals just as many other well-intentioned initiatives have in the past. And there is still a long way to go in reaching even baseline goals that were set more than a decade ago. According to the group charged with tracking the progress of the United Nations’ Millennium Development Goals around child and maternal health, as of 2012 fewer than one-third of the 75 countries where child deaths are highest were on track to meet the goal to reduce child mortality. 

This summer, GlobalPost correspondents reported from Bangladesh, India, Myanmar, Uganda, and Zambia in our Special Report, “Step by Step.” We found hopeful progress on the road to ending preventable deaths in some nations, and considerable challenges in others. The reporting team focused on what works – and what doesn’t – in the global push to ensure all children reach their fifth birthday.

While experts agree it is too early to quantify the precise impact A Promise Renewed has had, officials at USAID and UNICEF, the lead organizers of last year’s Washington meeting, said that the campaign has created momentum around child health at a time when the development community is looking beyond the Millennium Development Goals deadline of 2015. And they are not backing down.

“We can imagine a world without children dying for no need. We’re going to deliver that.”
~Rajiv Shah, USAID Administrator

“We can imagine a world without children dying for no need,” Rajiv Shah, administrator of the US Agency for International Development, told GlobalPost in an interview. “We’re going to deliver that.”


It is a mark of progress that the number of children who die before their fifth birthday has fallen substantially in the last two decades – from 12 million in 1990 to 6.9 million in 2011. More recent numbers to be released this month are expected to show an even further decline. But such global reductions have been uneven. Eighty percent of deaths in children under 5 occur in 25 countries, primarily in South Asia and sub-Saharan Africa. More than 40 percent of all under-5 deaths occur during the first month of life, where reductions have been particularly slow to come. Poor nutrition, water, and sanitation, along with poor access to education, health care, and family planning, all continue to contribute to young children dying.

In recognition of the variable progress that has been made in reducing child mortality, world health leaders unveiled a 68-page strategic plan during last year’s Washington summit to reduce preventable deaths that emphasized a “new way of doing business.” Among the more than 700 global leaders in health and international development at the gathering, called the Child Survival Call to Action, were then-Secretary of State Hillary Clinton, then-Ethiopian Minister of Health Tedros Adhanom Ghebreyesus, and even the American actor Ben Affleck.

The roadmap calls for focused efforts in those countries that have the greatest number of child deaths, like India and Nigeria, and on those areas that could drive the greatest future reductions, like neonatal care. Underscoring those targeted measures is the importance of robust and transparent national data. A country needs to know where its children are dying and what they are dying of in order to determine the highest impact intervention.

The plan sets as its goal not a relative reduction, as is the case with the United Nations’ Millennium Development Goals, but a firm number for all countries: By 2035, only 1 in 50 children (or fewer) would die before age 5, a number that would match the current average for developed countries. (In 2011, this global figure was much higher, at 1 in 20 children.)