The world has cut the child death rate by about 60% since 1990, but 4.9 million children still die before their fifth birthday each year, mostly from preventable or treatable causes, and progress has slowed sharply since 2015.
Updated October 13, 2026. Written from the sources listed below, not independently peer-reviewed.
Out of every 100 children who die before their fifth birthday, how many die in their first 28 days of life?
4.9 million
Children who died before age five
Including 2.3 million newborns in their first 28 days. Down from 10.1 million in 2000 and 13.0 million in 1990.
Data year 2024. Source: UN Inter-agency Group for Child Mortality Estimation, 2026
37.4 per 1,000
Under-five mortality rate
Deaths per 1,000 live births, down from 93.5 in 1990. The SDG target is 25 or lower in every country by 2030.
Data year 2024. Source: UN Inter-agency Group for Child Mortality Estimation, 2026
1.5%
Annual rate of decline, 2015–2024
Average yearly fall in the under-five mortality rate, compared with 3.9% a year in 2000–2015.
Data year 2024. Source: UN Inter-agency Group for Child Mortality Estimation, 2026
Unit: million deaths
Modelled UN IGME estimates for the years shown in the report's tables, rounded to one decimal. Each UN IGME round revises the full series, so these values should not be mixed with figures from earlier reports.
SDG target 3.2 asks every country to cut under-five mortality to 25 or fewer deaths per 1,000 live births, and newborn mortality to 12 or fewer, by 2030. In 2024 the global rates were 37.4 and 17.2. On current trends, 60 countries are at risk of missing the under-five target and 66 the newborn target. Meeting the targets would let an estimated 8 million more children survive to age five between 2025 and 2030.
Sub-Saharan Africa accounted for 2.8 million, or 58%, of all under-five deaths in 2024. Its under-five mortality rate of 71.6 per 1,000 live births was 14 times that of Europe and Northern America.
Source: UN Inter-agency Group for Child Mortality Estimation, 2026Sub-Saharan Africa and Southern Asia together had more than 80% of under-five deaths in 2024, but less than 60% of the world's live births.
Source: World Health Organization, 2026Children in fragile and conflict-affected countries faced an under-five mortality rate of 74.1 per 1,000 live births in 2024, nearly three times the rate elsewhere.
Source: UN Inter-agency Group for Child Mortality Estimation, 2026Children in the poorest households were about twice as likely to die before age five as those in the richest, and under-five mortality was about 1.5 times higher in rural than in urban areas.
Source: UN Inter-agency Group for Child Mortality Estimation, 2026Instead of one “percent solved” score, DO GOOD rates three separate dimensions. A problem can have mature solutions that still reach too few people. These ratings are an editorial reading of the sources on this page, not a measured index.
Has the situation improved in the real world?
ModerateAnnual under-five deaths fell from 13.0 million in 1990 to 4.9 million in 2024, one of the largest gains in global health. But 4.9 million children still die each year, and the newborn period now accounts for 47% of these deaths.
How mature and validated are the available solutions?
HighMost deaths are caused by conditions that known, low-cost measures can prevent or treat: vaccines, skilled care at birth, kangaroo mother care, breastfeeding, oral rehydration and zinc, antibiotics, and malaria prevention and treatment. The main gap is care for very small and sick newborns, which depends on staffed, equipped facilities.
How widely are effective solutions actually used?
ModerateCoverage of key services is broad but incomplete: in 2025, 85% of infants worldwide received all three doses of diphtheria-tetanus-pertussis vaccine, yet an estimated 13.5 million received no vaccine at all in their first year.
UN IGME estimates rest on decades of surveys and registration data and are published with uncertainty ranges. Data gaps are largest where mortality is highest, and each round revises earlier figures: the latest estimates are slightly higher than those published the year before.
The death rate is still falling, but its average annual decline dropped from 3.9% in 2000–2015 to 1.5% in 2015–2024, and the number of deaths has barely changed since 2022. UN agencies warn that reduced development assistance could slow progress further.
An estimated 4.9 million children died before the age of five in 2024, about 2.3 million of them in their first four weeks of life. The main causes are complications of preterm birth, complications during labour and delivery, pneumonia, diarrhoea and malaria, all of which can largely be prevented or treated with known, low-cost care. Since 2000, about 174 million children have died before their fifth birthday. The death rate has fallen by about 60% since 1990, but the number of deaths has stayed at roughly 4.8 to 4.9 million a year since 2022.
The risk depends heavily on where a child is born. Sub-Saharan Africa accounts for 58% of under-five deaths, and children in fragile and conflict-affected countries are nearly three times as likely to die as children elsewhere. Within countries, children in the poorest households, in rural areas and those whose mothers had little schooling face higher risks. If current trends continue, about 27 million more children will die before age five between 2025 and 2030, and UN agencies warn that reductions in development assistance threaten to slow progress further.
Most estimates come from the UN Inter-agency Group for Child Mortality Estimation (UN IGME), led by UNICEF and WHO. Because many countries do not register every birth and death, it combines several data sources with statistical models. The main measures are:
Under-five mortality rate
The probability that a newborn dies before reaching exactly five years of age, expressed per 1,000 live births. It is the headline indicator for child survival and for SDG target 3.2.
Neonatal mortality rate
The probability of dying in the first 28 days of life, per 1,000 live births. It isolates the newborn period, where nearly half of all under-five deaths now occur.
Number of deaths
The estimated count of children who die before age five in a year. It depends on both the death rate and the number of births, so it can stay flat even while the rate falls.
Modelled estimates
UN IGME combines civil registration, household surveys and censuses into country estimates with uncertainty ranges. Each round revises the whole series, so figures from different reports should not be compared directly.
What works
Routine vaccines protect against major killers of young children, including measles, whooping cough and the bacterial and viral infections behind much pneumonia and diarrhoea. In 2025, 85% of infants worldwide completed the three-dose diphtheria-tetanus-pertussis series.
Limits
An estimated 13.5 million infants received no vaccine at all in 2025, concentrated in fragile and hard-to-reach areas. WHO and UNICEF note that the full effect of recent cuts to international health financing is not yet visible in these figures.
What works
Complications of preterm birth (36%) and of labour and delivery (21%) are the leading causes of newborn death. A skilled health worker at birth, clean delivery, keeping the baby warm, help with breathing, early breastfeeding and prompt treatment of infections are the core of essential newborn care.
Limits
This care depends on functioning facilities with trained staff available day and night, reliable supplies and referral for emergencies. UN agencies say the high share of newborn deaths reflects slower progress in preventing deaths around the time of birth.
What works
Skin-to-skin contact with the mother plus exclusive breastfeeding was already known to reduce deaths by 40% among hospitalized babies weighing under 2.0 kg when started once they are stable. A WHO-coordinated trial in five countries found that starting it immediately after birth cut deaths by a further 25%, which WHO estimated could save up to 150,000 more lives a year.
Limits
It requires neonatal units where mothers can stay with their babies around the clock, staff trained to support them, and time and support for mothers. The trial was hospital-based, so results in other settings may differ.
What works
WHO estimates that nearly 400,000 deaths among children under five could be prevented each year if infants were exclusively breastfed for their first six months and breastfeeding continued to age two or beyond.
Limits
Only about 47% of infants under six months worldwide are exclusively breastfed. Mothers need practical support from health workers, families and employers, and malnutrition in older children also requires food security and treatment for acute malnutrition.
What works
Oral rehydration salts and zinc for diarrhoea, antibiotics for pneumonia, and testing and treatment for malaria are cheap and effective, and community health workers can bring them close to home. Malaria alone caused 17% of deaths among children aged one month to five years in 2024.
Limits
Treatment only helps if families recognise danger signs and reach care quickly. Community programmes need paid, supervised health workers, steady medicine supplies and working referral to hospitals.
Promising, but not proven at scale. The stage shows how far each approach has come; it is not a recommendation.
Respiratory syncytial virus is a major cause of severe lung infection in babies, and almost all infant deaths from it occur in low- and middle-income countries. In 2025 WHO recommended that countries introduce either a vaccine given to pregnant women or a long-acting antibody given to newborns. How quickly they can be made affordable and delivered at scale in low-income countries is not yet clear.
Two malaria vaccines are recommended for young children and are now part of routine immunization in a growing number of African countries. In pilots in Ghana, Kenya and Malawi, deaths from all causes fell among children old enough to be vaccinated. Protection requires four doses and complements, rather than replaces, nets and treatment.
Giving the antibiotic azithromycin to all young children in high-mortality areas reduced deaths in an earlier large trial in Niger. In 2020 WHO advised that, where countries use it, it should be limited to infants aged 1 to 11 months in high-mortality settings in sub-Saharan Africa, with monitoring of deaths and antibiotic resistance. A large trial in Mali published in 2025 found no reduction in deaths, so where and whether it works remains uncertain.
Implementation gap
UN IGME warns that reductions and uncertainty in development assistance threaten progress at a vulnerable moment, and notes that several studies suggest cuts to child health financing could mean millions of additional preventable deaths.
Implementation gap
Newborn deaths make up nearly half of under-five deaths, which UN agencies link to slower progress in preventing deaths around the time of birth. Closing this gap depends on well-equipped facilities and skilled staff available whenever a baby is born.
Implementation gap
An estimated 13.5 million infants received no vaccine at all in 2025. Children missed by vaccination are often also missed by other basic health services.
Coordination gap
Children in fragile and conflict-affected countries face an under-five mortality rate nearly three times higher than elsewhere. Insecurity, displacement and weak governance make it hard to keep clinics staffed and supplied, and require coordination between humanitarian and development actors.
Knowledge gap
Many high-mortality countries lack complete birth and death registration, so estimates rely on surveys and models. Data gaps are largest exactly where mortality and preventable causes are most concentrated.
Knowledge gap
More than 100,000 children aged one month to five years died from severe acute malnutrition in 2024, but UN agencies say the true burden is likely substantially underestimated because its indirect role in other deaths is not fully counted.
Unresolved questions, not vetted breakthroughs. Answering any of them would change what is possible.
How much of the slowdown is due to the shift of deaths towards the newborn period, to conflict and fragility, to population growth in high-mortality regions, or to stalled health system investment, and which levers would restart progress?
Why are so many babies born too early, often with no identified cause, and which forms of care can keep very small newborns alive where neonatal intensive care is not available?
How are recent reductions in development assistance changing vaccine coverage, supplies and staffing in high-burden countries, and how can these effects be measured quickly when surveys are also being cut?
Why did mass azithromycin reduce child deaths in some trials but not others, and can its benefits be targeted to where they are largest without speeding up antibiotic resistance?
Organisations that deliver vaccines, newborn care, nutrition and treatment for pneumonia, diarrhoea and malaria rely on donations. Look for groups that publish independent evaluations and cost data before you give.
Much child health work in high-burden countries depends on international aid and partnerships such as Gavi. Letting elected representatives know that you support this funding is one of the few ways individuals can influence it.
Breastfeeding saves lives and depends on practical support. Backing paid parental leave, space and time to breastfeed at work, and respectful support for parents helps make it possible.
Midwives, nurses, paediatricians, data analysts, supply-chain specialists and biomedical engineers can support newborn and child health programmes, especially in training, equipment maintenance and data systems.
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UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank Group, UN DESA Population Division), published 2026
The official global estimates, with data up to 2024, published in March 2026. Source of under-five deaths (13.0 million in 1990, 10.1 million in 2000, 7.1 million in 2010, 6.1 million in 2015, 4.9 million in 2024), the mortality rates of 93.5 (1990) and 37.4 (2024), the newborn share (47%), annual rates of decline, regional, fragility, wealth, rural and education gaps, countries at risk of missing SDG 3.2, projections to 2030 and the warning on development assistance.
World Health Organization (1 May 2026), published 2026
WHO's summary of the latest UN IGME estimates. Source of the leading causes, the stagnation of deaths at about 4.8 to 4.9 million a year since 2022, the share of deaths and births in sub-Saharan Africa and Southern Asia, and the projection of more than 27 million deaths in 2025–2030.
World Health Organization (news release, 18 March 2026), published 2026
Joint UN IGME launch release. Source of cause shares (preterm complications 36% and labour and delivery complications 21% of newborn deaths; malaria 17% of deaths at 1–59 months), deaths from severe acute malnutrition and its likely underestimation, slower progress around the time of birth, and the note that estimates are not comparable across rounds.
UNICEF and WHO (press release, July 2026), published 2026
Launch of the WHO/UNICEF national immunization coverage estimates for 2025. Source of DTP3 coverage (85%), 13.5 million zero-dose children, and the statement that the full impact of cuts to international health financing is not yet reflected.
World Health Organization (news release, 26 May 2021), published 2021
WHO summary of the multi-country randomized trial of immediate kangaroo mother care (Ghana, India, Malawi, Nigeria, Tanzania). Source of the 40% and further 25% mortality reductions and the estimate of up to 150,000 more lives a year.
World Health Organization (4 August 2026), published 2026
Source of the estimate that nearly 400,000 under-five deaths a year could be prevented by optimal breastfeeding, the 47% exclusive breastfeeding rate for infants under six months, and the link between malnutrition and about half of child deaths.