Global efforts have cut under-five deaths, but preventable child mortality remains a major challenge
The world has made remarkable strides in improving child survival over the last three decades. Since 2000, global efforts have reduced under-five mortality rates by half. A historic milestone was reached in 2022 when child mortality dropped below 5 million for the first time. Millions of children now have a better chance of reaching five.
Still, many children die of preventable causes despite this progress.
A total of 4.8 million children under five died in 2023 alone, which is equivalent to 13,100 preventable deaths every day. Millions continue to die from treatable causes, including infectious diseases like pneumonia, malaria, diarrhea, and meningitis, alongside preterm birth complications and malnutrition. Most of these deaths occur in low- and middle-income countries, with Sub-Saharan Africa accounting for 58% of them despite representing 28% of the global under-5 population. The majority of late stillbirths occur during labor, often due to maternal infections, prolonged or obstructed labor, or lack of timely medical attention.
The United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) reports that children born in sub-Saharan Africa are, on average, 18 times more likely to die before the age of five than those born in Australia and New Zealand. The agency said that under-five mortality is 80 times higher in the highest-mortality countries compared to the lowest.
Four out of every five deaths occur in sub-Saharan Africa or South Asia
Beyond the wide gaps in child mortality between countries, significant disparities also exist. Countries that suffer from conflict and fragility and lack access to food and medical care have the highest under-5 mortality rate in the world. Families in rural areas, lower-income households, or mothers with little education face higher risks, making these inequalities worse.
Funding cuts are threatening decades of progress in child survival.
A reduction in investment affects vaccination efforts, limits access to HIV/AIDS treatment, and reduces maternal health services, according to health experts. In some countries, clinics have shut down, supplies are running low, and immunization campaigns have been disrupted, threatening to reverse hard-won gains.
The cuts worsen existing challenges such as displacement, conflict, disease outbreaks, and climate change, all of which limit children’s access to adequate nutrition and healthcare. Experts said that without renewed political will and financial commitment to sustain child survival programs, millions more children may die from preventable causes, and progress toward reducing under-five mortality may stagnate or reverse.
ITo save lives and ensure that all countries are on track to achieve the Sustainable Development Goals by 2030, greater political will and urgent action are needed. The SDGs were set in 2015 by the UN General Assembly, calling for all countries to reach an under-5 mortality rate (U5MR) of at least as low as 25 deaths per 1,000 livebirths and a neonatal mortality rate (NMR) of at least as low as 12 deaths per 1,000 livebirths by 2030.
Alison Parker, UNICEF’s Deputy Regional Director for Eastern and Southern Africa and allAfrica‘s Melody Chironda discussed the main drivers of child mortality, barriers to progress, and the urgent need for integrated health solutions. Parker spoke about the role of immunization, community health workers, and stronger data systems in accelerating child survival, especially in fragile and underserved settings.
Parker leads the team that works closely with governments, partners, and communities across 21 countries to help ensure children not only survive but thrive, beginning with basics like health, nutrition, Water, Sanitation, and Hygiene (WASH), and protection from preventable diseases.
Tell us about your role in advancing child health and immunization.
A major part of my work focuses on expanding access to life-saving vaccines, strengthening primary health care systems to allow every child and woman to access essential health and nutrition services, whether they live in a remote village, urban settlement, or a humanitarian setting. I’m proud to be part of a team that’s driving innovation, equity, and results to advance children’s rights across the region.
What are the leading causes of child mortality today, and what systemic factors allow these preventable deaths to persist?
Today, the leading causes of child mortality are largely preventable and treatable, including pneumonia, diarrhoea, malaria, newborn complications, and vaccine-preventable diseases like measles, meningitis, neonatal tetanus, tuberculosis, and now typhoid. These are illnesses and diseases we know how to prevent and treat.
But what allows them to persist are systemic barriers: weak Primary Health Care (PHC) systems, limited access to essential services in remote or marginalized communities, underfunded PHC and immunization programs, and gaps in integrated interventions, including nutrition and water, sanitation and hygiene (WASH). In many cases, it’s not a lack of solutions, but issues around limited or inadequate focus on equity, timely investment, and sustained political will or action.
That’s why UNICEF, with our partners, is not only delivering vaccines, but we also work with governments, civil society, and communities to build resilient Primary Health Care systems, expand community-based PHC, and mobilize political leadership, ownership, and accountability for outcomes, and sustainable financing. Because ultimately, saving children’s lives is not only about knowing what to do, it is about ensuring the will, the resources, and the reach to actually do it.
Given that under-five mortality has halved since 2000 but progress has slowed, what factors are driving gains in child survival, and where are we falling short?
The remarkable progress we have seen since 2000 is one of global development’s great success stories. We’ve seen child deaths halved thanks to increased access to Primary Health Care services, including immunization, strengthened maternal, newborn, and childcare, improved nutrition, and the expansion of WASH, to name a few. These efforts, backed by strong political commitment in many countries, have saved millions of young lives.
But the slowdown in progress is a warning sign that must not be ignored. We’re falling short in reaching the “last mile” and the most vulnerable children in fragile settings, rural areas, and urban slums. Health systems remain too weak in many places, and underinvestment in community health workers, routine immunization, and early childhood services is leaving gaps.
To keep moving forward for every child, we need to double down on equity, bring services closer to where families live, and secure long-term, sustainable financing for child health, both domestically and globally. As I’ve said, the solutions are known – what is needed now is the resolve to finish the job and ensure that no child is left behind.
Nearly five million children under five still die annually from preventable causes, with 58% of these deaths in sub-Saharan Africa. What are the biggest barriers to eliminating these preventable deaths, and how do these barriers differ across urban, rural, or conflict-affected settings?
The heartbreaking reality is that most of these deaths are entirely preventable and treatable, from causes like pneumonia, diarrhoea, malaria, newborn complications, and undernutrition. The biggest barrier isn’t medical knowledge; it’s inequity in access.
In rural areas, the challenge is often about physical access; families live far from health facilities, roads are poor, and there may be too few trained health workers. In urban slums, services may exist, but overcrowding, poverty, and informal status create barriers to care. And in conflict-affected areas, health systems are disrupted or destroyed, making it extremely difficult to deliver even the most basic services.
Evidence also shows that limited decision-making power among women, low male caregiver involvement, and specific barriers faced by adolescent mothers reduce vaccine uptake and the ability to access health services in general.
Across all settings, we also see underinvestment in PHC, fragile health infrastructure, and limited skilled health care workers to provide quality essential health and nutrition services.
At UNICEF, we’re working with governments to decentralize care, strengthen frontline delivery, and build resilience, so that whether a child is born in a remote village or a displacement camp, they have the same chance to survive and thrive.
We are also supporting community-led solutions through social and behaviour change strategies and evidence-based, context-specific interventions that engage communities using participatory approaches such as Human-Centred Design (HCD). These approaches help identify and address specific needs and challenges, strengthen trust and demand for services, tackle gender-related barriers, improve the caregiver experience, and increase equitable immunization uptake, particularly among zero-dose children and underserved populations.
How can countries leverage immunization programs within integrated primary health care to strengthen the broader child survival agenda without losing focus?
Immunization across the life course is one of the most effective entry points for Primary Health Care; it brings families into contact with the health system early and regularly. Countries can build on this foundation by integrating with other critical health services, for example, offering nutrition screening, growth monitoring, early childhood care, and caregiver education alongside vaccines.
This kind of integration does not have to dilute the impact of the immunization efforts. We have seen this integration work well in many countries across the globe. We can, and we must, protect the integrity of immunization programmes while using them as a platform to reach children with other essential services. This requires an enabling governance and policy environment, strong planning, local coordination, and investment in frontline health workers who can deliver multiple interventions at the same touchpoint with children and families.
When done well, integrated immunization doesn’t slow progress; it can actually accelerate it. It helps us reach more children, with more of what they need, in the critical first years of life.
Children in fragile and conflict-affected settings are nearly three times more likely to die before age five. What specific strategies are proving effective in reaching these vulnerable populations? What role do community health workers or digital tools play in these strategies?
Children in fragile and conflict-affected areas face some of the highest risks, not because diseases are different, but because access is disrupted or not there. What is proving effective is a shift toward locally led, adaptable solutions.
First, community health workers are essential. They are trusted by families, can navigate insecure or hard-to-reach areas, and often deliver care where formal health services no longer function. Investing in them – meaning ensuring adequate training, fair payment, and equipping them with essential supplies, digital tools, and supportive supervision – is one of the most impactful things we can do.
Second, digital tools are transforming the response. Mobile platforms help map zero-dose children, monitor supply chains, and even support remote training and supervision when health workers are isolated. In some settings, real-time data has been the difference between a delayed response and a life saved.
UNICEF works closely with governments and partners to deliver health on the move through mobile clinics, integrated outreach, and tailored strategies that reflect the reality on the ground. It’s about meeting families where they are, not where we wish they were.
In fragile contexts, flexibility, innovation, and trust in communities are what turn survival into hope.
The solutions exist. Now it’s about the will to take them to scale and sustain them.
What are the main barriers to ending preventable deaths among women and children in African countries?
The biggest barriers to ending preventable deaths among women and children across Africa are not medical; they’re structural and systemic. We’re still seeing weak health systems, underinvestment in maternal and child health, and deep inequalities that leave the poorest and most remote communities behind.
Women are dying from complications we know how to treat. Children are dying from diseases we know how to prevent and treat. What’s missing is consistent access to quality care, especially at the community level, and the political and financial commitment and action needed to prioritize and protect children, especially the most vulnerable.
Overcoming these barriers requires three things:
- Strong, resilient Primary Health Care that reaches every mother and child.
- Equity-driven policies that put resources where the need is greatest.
- Accountability and leadership, from governments and partners, to ensure promises and policies are actioned.
The solutions exist. Now it’s about the will to take them to scale and sustain them.
How do we accurately measure progress in child survival to ensure we’re on track to meet the Sustainable Development Goals (SDG) 2030 targets for child health? What indicators are most reliable for tracking progress in sub-Saharan Africa?
To know if we’re truly making progress, we must look beyond national averages and ask: who are the most vulnerable, where are they, and what is needed to ensure they survive and thrive?
The most reliable indicators include the under-five mortality rate, neonatal mortality rate, and coverage of key interventions like immunization, skilled birth attendance, and antenatal care. We also need to track zero-dose children, those who’ve missed all routine vaccines, as a signal of where health systems are failing to reach.
In sub-Saharan Africa, household surveys like the Demographic and Health Survey (DHS) and Multiple Indicator Cluster Surveys (MICS) provide critical data, but increasingly, we’re also using real-time administrative data and digital tools to get a more timely picture of the on-the-ground programmatic performance. Equity-focused monitoring is key – disaggregated by region, wealth, and gender, so we don’t miss the children furthest behind.
At UNICEF, we believe data must underpin decision-making, not only be used for reports. Measuring what matters and acting on it is how we stay on track for the 2030 SDG targets.
What bold leadership steps should global health leaders and policymakers prioritize to accelerate child survival by 2030, particularly in addressing funding gaps and inequities?
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To meet the 2030 child survival targets, we need bold leadership that puts equity and accountability at the center of health systems.
First, leaders must prioritize domestic investment in Primary Health Care. No child should die because they were born in a remote village or an informal settlement. These children are also the country’s future workforce. Funding is key – it is not an expense; it is a government’s accountability and the smartest investment in a country’s future.
Second, we must close the equity gap by accessing the hardest-to-reach children, those who’ve missed vaccines, live in conflict zones, or face multiple layers of exclusion and vulnerability. That means funding must be targeted, data must be disaggregated, and progress must be measured in lives saved, not just services delivered.
Finally, we need to rethink what leadership looks like. Bold leadership listens to communities, empowers frontline workers, and removes barriers, whether financial, gender-based, socio-cultural, or geographic.
Accelerating child survival is not a question of whether we can. It’s whether we will. And that starts with political courage, sustained financing, strong and coordinated partnerships, and an unwavering commitment to every child’s right to life.
Malnutrition contributes to 45% of child deaths globally. What specific strategies will the forum explore to address malnutrition as a critical factor in child mortality?
Malnutrition is not just a cause of death; it’s a driver of illness, stunted growth, and developmental delays. It contributes directly to nearly half of all child deaths, and addressing it is essential for improving child survival.
At the recent Innovation and Action for Immunization and Child Survival Forum in Mozambique, we explored strategies that integrate nutrition into every stage of health care. This includes ensuring that pregnant women and infants receive the right nutrients from the start, strengthening community-based nutrition programs, and scaling up access to nutrient-rich foods and supplementation.
We also emphasized the importance of cross-sectoral action where nutrition is connected to clean water, sanitation, maternal health, and early childhood development. Affordable and sustainable solutions for nutrition must be scaled up to reach the most vulnerable populations, especially in rural and conflict-affected areas.
What are you personally hoping to contribute to – and take away from – the Innovation and Action for Immunization and Child Survival Forum, and how do you plan to apply these to accelerate progress in reducing preventable child deaths?
I’m excited to contribute by sharing UNICEF’s experience working with governments, partners, and communities to implement innovative, evidence-based solutions that ensure every child survives and thrives. This includes expanding immunization access, integrating nutrition and health services, and strengthening health systems in the hardest-to-reach areas.
From this important Forum, I take away new insights and partnerships that can help us scale up proven strategies, especially in areas where progress has been slower. The opportunity to exchange ideas and learn from other innovators is invaluable. I’m particularly focused on how we can better leverage digital tools, community health workers, and local leadership to accelerate our response and ensure equity.
Ultimately, what we take away from this Forum must lead to action on the ground. Which means applying the knowledge and connections discussed in Maputo this week, to continue to push for collective political will, financing, and systems needed to make preventable child deaths a thing of the past. The time is now. There is no other option.
