Table of Contents
Chapters
- Fertility Continues to Decline
- Contraceptive Use
- Contraceptive Method Mix
- Awareness and Availability of Contraception
- Other Direct Influences on Fertility
- Fertility Preferences
- Young Women
- Child Survival and Health
- Infant Mortality
- Under-Five Mortality
- Impact of HIV/AIDS
- Child Immunization
- Breastfeeding and Infant and Child Health
- Maternal Health
Highlights
- Is fertility decline slowing?
- The impact of contraception
- Intentions to use family planning
- Injectables becoming popular
- Desired family size falling
- Premarital sex: New findings
- How AIDS affects child survival
- Maternal care falls short
Published by the INFO Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA
Volume XXXI, Number 2,
Spring 2003
Series M, Number 17
Special Topics
Child Survival and Health
During the 1990s an average of 11 million children under age five died each year in developing countries, down from 20 million annually four decades earlier. In sub-Saharan Africa, however, deaths to children under five nearly doubled during this time, rising from an estimated 2.3 million per year to 4.5 million per year (117). In 2000, 43% of the world’s child deaths were among children living in sub-Saharan Africa, compared with 14% in 1960 (118).
Despite improvements in child survival in many developing countries, other countries have yet to meet the goals for reducing infant and child mortality set for 2000 at the 1990 World Summit for Children. Among these goals was reducing levels of infant mortality (the probability of a child dying between birth and age one) and under-five mortality (the probability of a child dying between birth and age five) either by one-third or to between 50 and 70 deaths per 1,000 births, whichever was less, by 2000 (123).
In surveys conducted from 1990 to 2001, 30 of 56 countries had achieved the World Summit goal for infant mortality, and for under-five mortality, just 19. In Cameroon, Kenya, and Haiti infant mortality levels fell to between 50 and 70 deaths per 1,000 births in their first surveys of the 1990s, but then rose above these levels by the next surveys.
Countries have failed to reach the World Summit goals for various reasons. Among them are reduced commitment to childhood immunization programs, conflicts and civil strife, and mother-to-child transmission of HIV (130, 142). In contrast, breastfeeding practices have improved in many countries since 1990, with more mothers adhering to feeding practices beneficial to infant and child health and survival.
Infant and child survival rates are linked to fertility rates (10, 43, 59). A study of 23 sub-Saharan African countries concluded that differences in child survival rates ac-counted for much of the differences in fertility rates among countries in the 1980s and 1990s (61). One reason is that when many of their children die, couples have strong motivation to have many children.
Before the demographic transition occurs in a country, mortality levels among infants and children alike are high. Deaths to children between one and five years account for most of under-five mortality levels. When mortality and fertility rates fall during the transition, deaths to children between one and five years decrease more rapidly than among infants under twelve months.
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Andrea Fisch During the past decade an average of 11 million children under the age of five died each year in developing countries. |
As countries make improvements in child health care, infant deaths will begin to account for most of the under-five mortality. Thus programs that have substantially improved child survival—immunization, oral rehydration therapy, treatment for acute respiratory infections—will need to be joined with greater efforts to improve infant survival, such as improved maternal health services and better nutrition during the early weaning period (14).
Infant Mortality
Among 56 developing countries surveyed since 1990, for every 1,000 children born, an average of 68 die by age one. Infant mortality rates vary widely within and among developing regions. On average, infant mortality levels are highest in sub-Saharan Africa (at 87 infant deaths per 1,000 births) and lowest in Latin America and the Caribbean (at 39 per 1,000). Among countries, infant mortality is highest in Mozambique, at 135 deaths per 1,000 births, and lowest in Colombia, at 21 deaths per 1,000 births (see Table 12).
Among 37 developing countries with more than one survey since 1990, infant mortality rates improved in 12 but worsened in 6. (Changes of fewer than 10 deaths per 1,000 births are not statistically significant and thus cannot be considered to reflect real changes in the mortality rate (96).) In sub-Saharan Africa infant mortality im-proved only in Ghana and Malawi; it deteriorated most in Côte d’Ivoire and Rwanda (see Table 12).
Elsewhere, average regional levels of infant mortality improved by between 16% and 19% from one survey to the next. In Bangladesh, Belize, Indonesia, Nicaragua, and Peru, infant mortality rates fell between 20 and 29 deaths per 1,000 births in the 6 to 9 year period between subsequent surveys. Of 28 surveyed countries outside sub-Saharan Africa, all except Cambodia, Haiti, Mauritania, Pakistan, and Yemen have reduced infant mortality to levels set as goals for 2000 at the World Summit for Children.
Infant mortality levels range widely among the nine countries with data in Eastern Europe and Central Asia, from as few as 14 deaths per 1,000 births in Ukraine to as many as 74 in Azerbaijan and Turkmenistan. Infant mortality is higher in Central Asia and the Caucasus than in Eastern Europe. With the exception of Kazakhstan, where infant mortality rates may have increased, infant mortality levels generally have decreased in the region since 1990.
