As the annual stocktaking on the progress of the Millennium Development Goals begins ahead of the next General Assembly session, there has been good news about the reduction in deaths of infants and children under age 5. But bright spots on the global map are not enough to ensure that Goal 4 can be met by the 2015 deadline. At the moment that looks unlikely.

Goal 4 calls for reducing under-5 mortality by two-thirds from the baseline year of 1990 to 2015. So far, a 35 percent drop has occurred, according to a 2011 report by a United Nations consortium, the Interagency Group for Child Mortality Estimation. The good news is that about 12,000 fewer children are dying every day, and the rate of decline is accelerating steadily, meaning more lives saved. In numerical terms, under-5 deaths declined to an estimated 7.6 million by 2010 from 12 million in 1990, even while populations rose.

Among the bright spots, 14 developing countries – of the 66 that once had under-5 mortality rates above 40 deaths in 1,000 live births — reduced their death rates by half or more between 1990 and 2010. Six of them – Bangladesh, Bhutan, Laos, Madagascar, Nepal and Timor-Leste — cut under-5 death rates by 60 percent or more. Regionally, North Africa and East Asia recorded the biggest overall drops of nearly two-thirds, ready to meet the Millennium Goal target on time.

The shadows being cast over this otherwise brightening picture are the persistently high rates in South Asia, sub-Saharan Africa and China, the UN consortium said in the Millennium Development Goals Report 2011 and an addendum update.

“About 70 percent of the world’s under-five deaths occurred in only 15 countries,” the UN said, “and about half in only five countries, by magnitude: India, Nigeria, Democratic Republic of the Congo, Pakistan and China. India (22 percent) and Nigeria (11 percent) together account for a third of under-five deaths worldwide.” India, where the population is still growing, will be the world’s most populous nation in little more than a decade, the UN Population Division estimates. Nigeria is the most populous country in Africa, the continent with the highest fertility rates.

In India, where government statistics are very reliable and many programs have been introduced to improve the lives of the poor in communities, India’s high under-5 death rate is the subject of critical reporting in the media and admonitions from government officials who blame failures or corruption at state and local levels to carry out projects.

In a speech on May 19 in Srinagar, the summer capital of the disputed region of Kashmir, claimed by both India and Pakistan and scene of a long-running separatist movement on the Indian-administered side, the federal family welfare minister, Ghulam Nabi Azad, called a spate of infant deaths at a leading local hospital “a matter of shame,” India’s Business Standard newspaper reported. In March, Azad reported to the upper house of the Indian Parliament that the country’s infant mortality rate was 46 per 1,000 births — “worse than those of Nepal, Sri Lanka and Bangladesh,” he said.

India’s registrar general, the head of the national census, collected data on the causes of child deaths, and the findings appeared in the British medical journal The Lancet in 2010. The results offer a window to understanding under-5 deaths not only in India but also in other developing countries where death rates are not decreasing to meet Goal 4. The need for comprehensive reproductive health care becomes obvious.

The Indian study found three leading causes of death among newborns: prematurity and low birth weight, neonatal infections and birth asphyxia or trauma. Among all under-fives, the two main causes of death were pneumonia and diarrhea diseases. Cultural factors also played a major role in the deaths of little girls, who in a region where the status of women is not high were five times more likely to die of pneumonia and four times more likely to die of diarrhea diseases than boys in comparative groups elsewhere.     

The UN report reflects these findings and adds others from different regions of the world. Globally, the UN interagency group said, the leading killers were the same: pneumonia, diarrhea-related disease, birth complications and birth asphyxia. It added malaria in sub-Saharan Africa and pointed to undernutrition as a factor in many developing countries.

Among the numerous nongovernmental organizations also working on projects to reduce under-5 mortality, Save the Children focuses on a campaign it calls “the first 1,000 days,” from the beginning of a mother’s pregnancy to the child’s second birthday. In a recent report, State of the World’s Mothers 2012, Save the Children said: “The right nutrition during this window can have a profound impact on a child’s ability to grow, learn and rise out of poverty.” Effects of malnutrition at birth may be irreversible.

The report estimated that malnutrition is the underlying cause of 2.6 million child deaths a year, and that those who survive may be mentally and physically impaired for life. Mothers and  babies need good nutrition, but “complex social and cultural beliefs in many developing countries put females at a disadvantage and, starting from a very young age, many girls do not get enough to eat.”

Once again, the interlinked nature of many or perhaps most of the Millennium Goals is apparent. Undernourished girls, perhaps given away as child brides, give birth too young to another generation of malnourished children. Maybe it is time to start rethinking the goals as all dependent on the status of women as the crucial factor in human development. Political will is needed to back strategies for enhancing the lives of women and girls. “Economic growth is not enough to fight malnutrition,” Save the Children says.

This article is the fourth in a series assessing the status of the Millennium Development Goals.

Additional resources

Nagging Hunger Undermines Millennium Poverty Goal (Goal 1)

Five Countries Hold Back Success at Meeting Child Mortality Goal (Goal 2)

Promoting Women Starts Early, in First Grade (Goal 3)

The Spotlight Returns to Family Planning (Goal 5)

Epidemics and Fake Drugs Hurt Global Health Improvements (Goal 6)

Scrutinizing Millennium Goal Claims as 2015 Looms (Goal 7)

Barbara Crossette

Barbara Crossette is the senior consulting editor and writer for PassBlue and the United Nations correspondent for The Nation. She is also a member of the Council on Foreign Relations. She has also contributed to the Oxford Handbook on the United Nations.

Previously, Crossette was the UN bureau chief for The New York Times from 1994 to 2001 and previously its chief correspondent in Southeast Asia and South Asia. She is the author of “So Close to Heaven: The Vanishing Buddhist Kingdoms of the Himalayas,” “The Great Hill Stations of Asia” and a Foreign Policy Association study, “India Changes Course,” in the Foreign Policy Association’s “Great Decisions 2015.”

Crossette won the George Polk award for her coverage in India of the assassination of Rajiv Gandhi in 1991 and the 2010 Shorenstein Prize for her writing on Asia.