By Josh Katz, Alicia Parlapiano and Margot Sanger-Katz

Sept. 17, 2019

Two decades ago, nearly 10 million children did not live to see a 5th birthday.

By 2017, that number — about 1 in every 16 children — was nearly cut in half, even as the world’s population increased by more than a billion people.

The sharp decline in childhood mortality reflects work by governments and international aid groups to fight child poverty and the diseases that are most lethal to poor children: neonatal disorders, pneumonia, diarrhea and malaria. But the results are also highly imbalanced. In some places, children’s health has improved drastically. In others, many still die very early.

From 2000 to 2017, all but one of the 97 low-to-middle-income countries that account for the vast majority of deaths of young children lowered their child mortality rates, according to a report released Tuesday by the Bill and Melinda Gates Foundation, along with a research team at the Institute for Health Metrics and Evaluation at the University of Washington, led by Stephen Lim, the institute’s senior director of science and engineering.

The data reveal a wide disparity of outcomes in early child mortality both across countries and within them. The researchers project that if current rates of progress continue, nearly two-thirds of children in the poorest countries will still live in districts that won’t meet United Nations development goals by 2030.

“The inequality in that progress is still quite stunning,” Mr. Gates said in a call with reporters.

By combining detailed survey data with statistical models, the researchers were able to map child mortality in much greater geographic detail than previous estimates. The exception to the trend of improvement was Syria, which has endured a devastating civil war.

Experts say reduced childhood mortality is also a marker of healthier, more stable conditions for adults. Lawrence Gostin, a professor of global health law at Georgetown University and director of the World Health Organization’s center on global health law, described it as a health version of “the canary in the coal mine.”

Mothers who lose fewer young children tend to have fewer children, reducing their own risk of death in childbirth and increasing their ability to improve the economic prospects of their households, said Ashish Jha, a physician with the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute. “It has huge implications for the family,” he said.

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Under-five mortality (UNICEF)