Introduction and Background
The High-Level Panel of Eminent Persons (HLPEP) notes in its work on developing post-2015 goals that ”… [i]nvesting more in health, especially in health promotion and disease prevention, like vaccinations, is a smart strategy to empower people and build stronger societies and economies” (United Nations, 2014, p. 38). It argues that solutions for child mortality are simple and affordable, and that therefore all preventable deaths should be averted by 2030, with a specific aim ”… for an upper threshold of 20 deaths per 1000 live births in all income quintiles of the population” (United Nations, 2014, p. 38).
While estimating the feasibility of reducing infant deaths overall, we zoom in on neonatal mortality (deaths in the first 28 days of children's life), which accounts for over 40 percent of total under-five mortality today and will become the main area to tackle for most countries if major progress in under-five mortality is to be made over the next 15 years.
Under-five Mortality Today and Global Progress Made over the Period 1990–2013
Major progress has been made in the realm of child mortality over the past 40 years. While close to 18 million children died before reaching their fifth birthday globally in 1970, this had been reduced to less than 7 million in 2013 (UN Inter-agency Group for Child Mortality Estimation [IGME], 2014), at the same time as the number or births has increased.
Table 14.1 shows that there has also been a shift in the distribution of deaths within the first five years: while early neonatal mortality (deaths in the first seven days of children's lives) accounted only for about 22 percent in 1970, it accounts for 32 percent of total mortality today; less than 29 percent of total under-five deaths today occur among children after the first 12 months of their life.
Figure 14.1 shows the current child mortality burden by cause of death, highlighting the relatively large share of current under-five mortality occurring in the neonatal period (first 28 days) and that the most common cause is simple prematurity. This analysis also shows the rather remarkable progress in reducing mortality from infectious diseases.