Child Mortality Under Five: Why Progress Is Slowing Despite Proven Interventions

How Many Children Die Before Age Five Each Year?

According to new estimates released by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), approximately 4.9 million children worldwide died before reaching age five in 2024. Of these, roughly 2.3 million were newborns who died within the first 28 days of life — a period that remains the most vulnerable window in a child's survival.

The leading causes of death in children under five continue to be conditions that are largely preventable and treatable: pneumonia, diarrhea, malaria, and neonatal complications such as preterm birth, birth asphyxia, and sepsis. Malnutrition is an underlying contributor in a significant share of these deaths, weakening children's immune defenses and making common infections fatal. Sub-Saharan Africa and South Asia continue to bear a disproportionate burden, accounting for the vast majority of under-five deaths globally.

Why Is Progress in Reducing Child Mortality Slowing Down?

Global child mortality has fallen substantially since 2000 — the under-five mortality rate has dropped by more than half over the past two decades, according to WHO and UNICEF data. However, the rate of decline has slowed in recent years. Health system disruptions caused by the COVID-19 pandemic interrupted routine immunization programs and essential child health services in many low-income countries, setting back gains that took years to achieve.

Beyond the pandemic, ongoing armed conflicts, forced displacement, and the effects of climate change — including drought, flooding, and food insecurity — are undermining health infrastructure in the most vulnerable regions. Experts also point to a persistent gap in access to basic healthcare: many mothers and newborns in rural and underserved communities still lack access to skilled birth attendants, essential newborn care, and timely treatment for childhood illnesses. Without accelerated investment in primary healthcare systems, meeting global targets for child survival will remain out of reach.

What Proven Interventions Can Prevent Child Deaths?

WHO and UNICEF emphasize that the majority of child deaths are preventable using well-established, affordable interventions. Immunization against diseases like measles, pneumococcal pneumonia, and rotavirus diarrhea has been one of the most successful public health tools, preventing millions of deaths annually. Oral rehydration salts (ORS) and zinc supplementation for diarrhea, antibiotics for pneumonia, and insecticide-treated bed nets for malaria remain highly effective strategies that cost relatively little to deliver at scale.

For newborns, the greatest impact comes from ensuring access to skilled care during childbirth, immediate skin-to-skin contact, early and exclusive breastfeeding, and prompt treatment of neonatal infections. Community health worker programs have also shown strong results in reaching remote populations with essential services. Global health organizations are calling for renewed political commitment and increased funding to scale these proven interventions, particularly in sub-Saharan Africa, where progress must accelerate dramatically to close the gap.