Reducing U5M has long been a priority of the international health community, gaining traction with the adoption of the UN Millennium Development Goals (MDGs) in 2000, and the subsequent update of the Sustainable Development Goals (SDGs) in 2015.

Goal #4 of the MDGs was to reduce the rate of under-five mortality by two-thirds by 2015, compared to the 1990 level. While the world made great progress from 1990 to 2015, we missed this goal, as the global under-five mortality rate declined by just under half, from 82 deaths per 1,000 live births in 1990 to 43 in 2015 .8  In terms of absolute numbers, globally, the number of under-five deaths have decreased from 12.7 million in 1990 to 6 million in 2015 .1

Projected U5MR through 2030, vs SDG goal

Data Source: IHME

The progress achieved to date was driven by affordable and effective under-five mortality interventions, including vaccines, micronutrient supplementation, breastfeeding education, malaria control, and neonatal care improvement. In addition, implementation strategies supported effective coverage of interventions, while accounting for contextual factors further enabled progress during this period.

Ending U5M by 2030

Because MDG #4—which called for a two-thirds worldwide reduction in under-five mortality by 2015—was not met, the UN established a new set of goals in 2015: the Sustainable Development Goals (SDGs). SDG #3 sets an absolute target for all countries, rather than a relative reduction at the global level. Specifically, for all countries, it calls for an under-five mortality rate of no higher than 25 deaths per 1,000 live births and a neonatal mortality rate of no higher than 12 deaths per 1,000 live births.

To meet this target by 2030, the global child mortality rate must drop by six to nine percent every year. According to UNICEF, 118 countries have already met this target and another 26 are on track to meet it. But 51 countries will need to accelerate progress, including 30 (mostly in sub-Saharan Africa) which need to more than double their current rate of reduction to reach the target by 2030.

Governments, donors, bilateral agencies, multilateral organizations, civil society, and the private sector are working to help make this happen, developing innovative tools to address the root causes of U5M and strategies to ensure these are effectively implemented for all. 2

UNICEF’s current strategic plan has established targets that address SDG #3.3 By 2021, it aims to have 120 million babies born safely at health facilities (an increase from 25 million), 30 million children with suspected pneumonia receiving appropriate antibiotics (an increase from six million), and six million children with severe acute malnutrition admitted for treatment (an increase from 3.4 million).

The WHO has set key targets for 2023, including a 30 percent reduction of U5M – which is to be aided by its other goal of increasing to 80 percent the number of children under five who are on track in health, learning, and psychosocial well-being.4

Meeting our Goals

As seen in the above trendline, current projections show the global average nearing SDG #3 by 2030 (projections are to reach 28 deaths per 1,000 live births, compared to the goal of 25). As noted above, however, many countries have significant progress to make to achieve this goal.

A demographic shift in one of the world’s most vulnerable regions threatens even that delayed success. Sub-Saharan Africa experienced the largest decline in child mortality between 2000 and 2015: estimates from IHME, for example, indicate that the under-five mortality rate dropped from 173 deaths per 1,000 live births in 1990, to 85 in 2015. 5  However, continued high total fertility rates in this region have meant increased total births and corresponding increased total numbers of child deaths. 6  Continued population growth may strain government resources and delay further progress, while short birth intervals and high fertility rates also stress family capacity to care for sick children and stretch household resources. These factors increase the risk of mortality among children before the age of five in addition to increasing the total number of deaths. 7

Overall, while there are challenges in reducing under-five mortality and neonatal mortality, the combination of evidence-based interventions, proven implementation strategies, and accounting for contextual factors will help countries make strides towards these goals.

  1. 1
    GBD 2017 SDG Collaborators. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392: 2091–138. Accessed January 21, 2020.
  2. 2
  3. 3
    United Nations Children’s Fund (UNICEF). UNICEF Strategic Plan 2018-2021: Executive Summary. New York: UNICEF; 2018. Accessed May 17, 2019.
  4. 4
    WHO, Draft thirteenth general programme of work 2019−2023, Targets and indicators, published March 2018, accessed March 27, 2018,
  5. 5
    UN Inter-agency Group for Child Mortality Estimation. Levels & Trends in Child Mortality Report 2018. New York: UNICEF (on behalf of UN IGME); 2018. Accessed May 17, 2019.
  6. 6
    Wang H, Liddell CA, Coates MM et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2014; 384 (9947). 957 - 979.
  7. 7
    Gebretsadik, and Gabreyohannes, E. Determinants of Under-Five Mortality in High Mortality Regions of Ethiopia: An Analysis of the 2011 Ethiopia Demographic and Health Survey Data. International Journal of Population Research. 2016; 1602761. Accessed January 7, 2020.
  8. 8
    Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease Study (GBD 2017). Seattle, WA: IHME; 2018.