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Child Mortality Rates Falling Faster than Expected

WASHINGTON, May 24 2010 (IPS) - With only five years left to meet the Millennium Development Goals’ 2015 deadline for reducing child mortality, progress toward that goal may be coming faster than was previously thought.

Past studies have indicated many countries are not moving quickly enough toward the goal of a two-thirds reduction in deaths of children under five years old, but a new study sees an acceleration of this reduction in several low-income countries.

The study, published online Monday by the British medical journal The Lancet, finds that 7.7 million children under five are projected to die this year – down from the 11.9 million who died in 1990.

While other studies have also pointed to decreasing child mortality rates, this study finds the most dramatic decreases. Those new findings are a result of new methods of analysing data and using it to predict and generalise child mortality trends.

“This undoubtedly is the biggest advance in mortality measurements in four decades. Seriously,” said Alan Lopez, head of the School of Population Health at the University of Queensland and a co-author of the study.

Of the 7.7 million projected deaths in 2010, 5.4 million are anticipated to be children under a year of age, with 3.1 million of those from children who die within the first month of being born.

Those neonatal deaths are the largest category of child mortality, but the study finds that even the rates of neonatal deaths are declining. Previous estimates have shown little or no improvement.

The overall numbers of child mortality are declining faster than expected as well. Globally, child mortality rates have declined around two per cent a year over the past two decades, according to the study.

Moreover, the authors found that the decline in child mortality rates accelerated between 2000 to 2010 versus 1990 to 2000 in many parts of the world, especially in parts of Latin America, North Africa and Southwest Asia.

The drop in child mortality rates has not been as fast in the U.S. While it, too, has seen fewer child deaths, the drop-off has not been as significant as elsewhere. The Czech Republic and Malaysia were both ranked below the U.S. in child mortality rate in 1990, but have since cut their rates by about 70 percent, surpassing the U.S. The U.S.’s rate has only declined by 42 percent in the last decade.

The authors found that Singapore leads all countries with the lowest child mortality rate in the world after it cut its rate by 75 percent since 1990.

Less than one percent of child deaths occur in high-income countries like the U.S. and Singapore, the study notes, with a third occurring in south Asia generally and nearly half in sub-Saharan Africa.

Another study released Monday by The Lancet found that maternal health has improved such that there were about 251 maternal deaths per 1,000 live births in 2008, compared with 422 in 1980. This marks substantial progress towards Millennium Development Goal 5, which seeks a three-quarters reduction in the maternal mortality ratio between 1990 and 2015.

An evolution of measurements

Not all health data experts were convinced the modelling used in the child mortality study was as accurate and certain as some might like it to be.

In a panel discussion on the measuring child mortality at the Kaiser Family Foundation Monday, Ed Bos, lead population specialist at the World Bank, pointed out that there was a “large difference” between the new study’s numbers and those published in a different study in the same journal three years ago.

Trevor Croft, a principal demographic expert at ICF Macro, said countries have varying levels of data. He singled out Angola as the most obvious case in which the actual numbers might vary widely.

Croft’s overall concern was that some child mortality rate numbers in the study might be a little low and “should maybe be seen as a lower boundary”, rather than the actual estimates.

Lopez, who was also a co-author on the 2007 paper, acknowledged the difficulties and the confusing conclusions one might draw from comparing the results of different studies.

But he sees the modelling used in the current paper as groundbreaking and part of a “rapid evolution of mortality measurements”.

That evolution could have broad impacts for global health. Having accurate data is key to getting countries to agree to financial commitments at meetings like the G8 Summit to be held in Canada next month, according to Kenji Shibuya of the Department of Global Health Policy at the University of Tokyo.

“We know the global health community would like a single number,” Lopez said, but it should not be scared of scientific uncertainty.

He did emphasise the need for transparency and honesty regarding uncertainty over data and projections as important components of any study. He also hoped that countries would take measures to improve the collection and records of data related to child mortality and that more sharing of data would take place between researchers.

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