The global under-five mortality rate has been reduced from 90 deaths per 1,000 live births in 1990 to 65 in 2008. Yet the rate of decline in under-five mortality is still insufficient to reach the MDG goal by 2015, particularly in sub-Saharan Africa and South Asia. In fact, the highest rates of mortality in children under 5 years old continue to occur in sub-Saharan Africa, which accounted for half of child deaths worldwide in 2008 – 1 in 7 children in the region died before their fifth birthday. South Asia accounted for one third of child deaths in 2008.

While substantial progress has been made in reducing child deaths, children from poorer households remain disproportionately vulnerable across all regions of the developing world. Under-five mortality rates are, on average, more than twice as high for the poorest 20 per cent of households as for the richest 20 per cent. Similarly, children in rural areas are more likely to die before their fifth birthday than those in urban areas.

An analysis of data from Demographic and Health Surveys indicates that in many countries in which the under-five mortality rate has declined, disparities in under-five mortality by household wealth quintile have increased or remained the same. In 18 of 26 developing countries with a decline in under-five mortality of 10 per cent or more, the gap in under-five mortality between the richest and poorest households either widened or stayed the same – and in 10 of these countries, inequality increased by 10 per cent or more (see chart on page 23).

Most children in developing countries continue to die from preventable or treatable causes, with pneumonia and diarrhoea the two main killers. The proportion of neonatal deaths is increasing, accounting for 41 per cent of all underfive deaths in 2008. Undernutrition contributes to more than a third of all under-five deaths.