Every year figures on child deaths are released to track how countries are progressing towards Millennium Development Goal 4 — to reduce the under-five mortality rate by two-thirds between 1990 and 2015.
Reductions in under-five mortality are usually reported as national averages however, masking the unequal progress across different groups within a country.
A new Save the Children paper entitled “Inequalities in child survival: looking at wealth and other socio-economic disparities in developing countries” outlines a number of important issues surrounding children’s unequal survival prospects.
Across the developing world, countries with lower levels of under-five mortality tend to have more inequality in child mortality between the richest and poorest households.
Child deaths are more concentrated in poor households in developing countries that have reduced under-five mortality the fastest. This suggests that these countries made progress at the expense of poor households.
A few, like Egypt, however have managed to improve child survival and narrow disparities in under-five mortality between the rich and poor at the same time. Cases like these prove that inequalities in child survival can be avoided.
Unequal survival chances between rich and poor children are driven by a host of factors. Poor households often lack clean water and sanitation, cannot afford to buy nutritious food and have no access to medical care making their children more vulnerable to diseases.
These deprivations are both driven by and contribute to poverty, joblessness, low female education, weak health systems and poor governance. Wealth is an important but not the only determinant of inequalities in child survival. Unequal survival outcomes are present across gender, ethnicity, caste and tribe.
India perfectly mirrors the child survival story in the developing world. While under-five mortality has fallen in India, high and sustained growth rates in recent years have not been enough to put the country on-track for the MDG 4 target.
Child survival varies in different parts of the country. Southern states like Kerala and Tamil Nadu have brought down under-five mortality way below the national average, while northern states are lagging behind.
For example, the under-five mortality rate in Rajasthan is more than twice that of Tamil Nadu. The poorest children in India are three times more likely to die than those from the richest households.
Girls are less likely to survive to their fifth birthday than boys, and so are children from scheduled castes compared to the average under-five population.
There is some good news however. A of number of poor countries have shown that it is possible to make a dent on child deaths with limited resources. Bangladesh, which is on-track to meet MDG 4, has significantly improved child survival with only modest economic growth.
It has done so by rolling-out effective but inexpensive interventions widely, ensuring that the poor is not left behind. For example, coverage for immunisation against measles—one of the most common causes of child deaths—went up from 62% in 1996-97 to 80% in 2007 among the poorest households.
Coverage gaps in measles vaccination between boys and girls have effectively disappeared in the past decade according to the Countdown to 2015 Decade Report. Other socioeconomic disparities in under-five mortality still need to be addressed in Bangladesh however, such as unequal survival chances in urban and rural areas.
World leaders will meet in a UN Summit in September to accelerate progress towards the MDGs. With only five more years to go before the deadline, it is just right to put pressure on national governments and donors to agree on an action agenda.
We should not forget to press them for a more equitable achievement of the goals. In the case of child survival, meeting MDG 4 at the national average but leaving poor children behind makes it a shallow achievement.
To better understand these issues, read our paper and engage in the debates in the run up the Summit.