Infant and Child Mortality: Causes, Trends, and Global Variations

Every year, millions of children die before they reach their fifth birthday, and the overwhelming majority of these deaths are preventable. Behind the statistics lies a story of remarkable progress, stubborn inequality, and the enormous influence that geography, income, and access to healthcare have on whether a child survives. Understanding why young children die, and how those reasons differ from one part of the world to another, is the first step toward closing the survival gap that still divides the planet.

What the numbers tell us
The leading causes of child death
The newborn period: the most dangerous weeks
After the first month: infectious diseases take over
Regional variations: why geography decides survival
The concentration of deaths in sub-Saharan Africa and South Asia
A different pattern in high-income countries
The decline of infectious-disease deaths in Asia and Latin America
India’s progress and its remaining challenges
Why progress is slowing and what it means

What the numbers tell us

Child mortality is measured using two key indicators. The infant mortality rate (IMR) is the probability that a child born in a given year will die before turning one, expressed per 1,000 live births. The under-five mortality rate (U5MR) measures the probability of dying before age five. A third, narrower indicator, the neonatal mortality rate (NMR), captures deaths in the first 28 days of life. These rates are widely treated as among the most sensitive measures of a population’s overall health and socioeconomic development.

The global picture has improved dramatically over a single generation. The global under-five mortality rate fell by about 60 per cent, dropping from 93.5 deaths per 1,000 live births in 1990 to 37.4 in 2024. Put another way, 1 in 27 children died before age five in 2024, compared with 1 in 11 back in 1990. Yet even with this progress, an estimated 4.9 million children died before their fifth birthday in 2024, including 2.3 million newborns.

There is a worrying caveat to this success. The pace of improvement is slowing. The annual rate of reduction in under-five mortality dropped from 3.9 per cent during 2000-2015 to just 1.5 per cent during 2015-2024. If current trends hold, the world is set to fall short of its Sustainable Development Goal target of ending preventable child deaths by 2030.

The leading causes of child death

Most child deaths come from a short, predictable list of causes, and almost all of them are either preventable or treatable with existing tools. The timing of death matters enormously, because the dangers a newborn faces are very different from those facing a toddler.

The newborn period: the most dangerous weeks

The first month of life is now the riskiest. Newborn deaths account for nearly half of all under-five mortality, a sign that progress in preventing deaths around the time of birth has lagged behind progress in older children. The two biggest killers of newborns are complications from preterm birth and complications during labour and delivery, such as birth asphyxia and birth trauma. Preterm birth complications cause about 36 per cent of newborn deaths and labour and delivery complications another 21 per cent, with infections like neonatal sepsis and congenital anomalies also contributing heavily.

Preventing these deaths depends on the quality of care a mother and baby receive before, during, and immediately after birth. Skilled birth attendants, antenatal check-ups, and essential newborn care, including keeping the baby warm, supporting breastfeeding, and treating infections quickly, can save the majority of these lives.

After the first month: infectious diseases take over

Once a child survives the newborn period, the threat shifts decisively toward infections. For children aged 1 to 59 months, pneumonia, diarrhoea, and malaria remain the leading killers, often made far deadlier by malnutrition. Looking at under-five deaths as a whole, prematurity (18 per cent), lower respiratory infections such as pneumonia (13 per cent), and birth asphyxia or trauma (10 per cent) together account for more than 40 per cent of deaths.

Malnutrition deserves special attention because it acts as a silent multiplier. For the first time, global estimates found that more than 100,000 children aged 1-59 months died directly from severe acute malnutrition in 2024. The true burden is much larger, because malnutrition weakens a child’s immune system and increases the risk of dying from otherwise survivable infections, yet it is rarely recorded as the underlying cause.

Regional variations: why geography decides survival

One of the starkest truths about child mortality is how unevenly it is distributed. A child’s odds of survival depend heavily on where they are born. The risk of under-five death in the highest-mortality country is around 80 times greater than in the lowest.

The concentration of deaths in sub-Saharan Africa and South Asia

Child deaths have become geographically concentrated. About 85 per cent of all under-five deaths in 2024 occurred in just two regions: sub-Saharan Africa (around 60 per cent) and South Asia (around 25 per cent). Sub-Saharan Africa’s share has actually grown over time. It rose from 30 per cent of global under-five deaths in 1990 to 60 per cent in 2024, partly because mortality has fallen faster elsewhere and partly because the region’s child population is growing.

In these high-burden regions, infectious diseases dominate. Pneumonia, diarrhoea, and malaria disproportionately affect children in poorer settings and remain highly prevalent, especially in sub-Saharan Africa. Malaria is a particularly clear example of geographic concentration. It is the single largest killer of children aged 1-59 months, and most malaria deaths occur in endemic areas of sub-Saharan Africa, concentrated in a handful of countries where conflict, climate shocks, and drug resistance hamper prevention and treatment.

A different pattern in high-income countries

In wealthier nations the picture is almost reversed. Clean water, sanitation, vaccines, and accessible medical care have driven infectious-disease deaths down to very low levels, so the remaining causes of child death look entirely different. In high-income settings, injuries become a leading cause of death among children, including road traffic crashes, drowning, and falls, alongside congenital conditions. Across the WHO European Region, for instance, injuries are the leading cause of mortality in children and adolescents, and the burden falls hardest on lower-income countries within the region, showing that even injury deaths follow a socioeconomic gradient.

This contrast carries an important lesson. When societies conquer infectious disease, child survival improves so much that the surviving risks are the kind that engineering, regulation, and safety measures can address. The persistence of infectious-disease deaths in poorer regions is therefore not inevitable but a marker of unequal access to basic services.

The decline of infectious-disease deaths in Asia and Latin America

The encouraging counterpoint to these disparities is how rapidly some regions have driven down childhood infectious-disease deaths through better healthcare. East Asia stands out. From 2011 to 2023, East Asia recorded the largest decrease of all regions, a 68 per cent fall in the under-five mortality rate, driven by better nutrition, vaccines, and stronger health systems.

Latin America has followed a similar trajectory. Reductions in deaths from diarrhoeal and respiratory infections have been a major engine of improving survival there. The Global Burden of Disease analysis notes that regions including Andean Latin America gained around 1.6 years in life expectancy thanks to reduced deaths from lower respiratory infections, while the long-term retreat of enteric (gut) diseases in young children reshaped survival across many middle-income countries.

These gains were not accidental. They came from oral rehydration therapy for diarrhoea, expanded immunisation, improved nutrition, clean water and sanitation, and broader access to primary healthcare. The same toolkit that worked in East Asia and Latin America is exactly what remains underused in the highest-mortality regions today.

India’s progress and its remaining challenges

India offers a striking example of sustained improvement. According to the Sample Registration System Statistical Report for 2024, the infant mortality rate declined to 24 and the under-five mortality rate stood at 28 per 1,000 live births, with the state of Kerala recording an IMR as low as 8. Over three decades, India’s under-five mortality rate fell by 75 per cent, surpassing the global reduction of 58 per cent, and its infant mortality rate fell by 69 per cent against a 55 per cent global decline.

The causes of child death in India closely mirror the global pattern. The leading causes of infant mortality are prematurity and low birth weight (about 31.6 per cent), pneumonia (16.2 per cent), and birth asphyxia and birth trauma (10.2 per cent), with congenital anomalies, sepsis, and diarrhoeal diseases also featuring. This breakdown shows that India sits at a transitional point: still battling preventable infections and birth-related complications, while gradually moving toward the profile of higher-income regions.

Much of India’s progress has been driven by public-health programmes, including a vast immunisation effort. The country’s Universal Immunization Programme provides free vaccination services each year to crores of pregnant women and infants, alongside investments in institutional delivery, newborn care units, and nutrition. The remaining task is to extend the reach and quality of these services to the poorest households and most underserved districts, where mortality stays stubbornly high.

Why progress is slowing and what it means

The deceleration in global child survival is not a mystery. The slowdown is linked to reduced funding for child-health programmes, unequal healthcare access, and persistent socioeconomic disparities that limit the reach of essential services such as nutrition and vaccination. Conflict and fragility make matters worse: children in fragile and conflict-affected settings are nearly three times more likely to die before age five than children elsewhere, and almost half of all under-five deaths now occur in such settings.

The deepest message running through the global data is one of inequality rather than scarcity of solutions. The interventions that save children’s lives, including skilled birth attendance, vaccines, antibiotics for pneumonia, oral rehydration for diarrhoea, bed nets for malaria, and adequate nutrition, are well known, low-cost, and proven. The reason millions of children still die is that these tools do not reach the children who need them most. Geography, household income, a mother’s education, and whether a family lives in a stable or conflict-affected area still shape a child’s chance of survival far more than they should.

What do you think? If the medical knowledge to prevent most child deaths already exists, what would it take to close the gap between regions where children rarely die young and those where they still do? And as countries succeed against infectious disease and the leading causes shift toward injuries and chronic conditions, how should health systems adapt to keep protecting their youngest?

References

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Table of Contents

What the numbers tell us 🔗

The leading causes of child death 🔗

The newborn period: the most dangerous weeks 🔗

After the first month: infectious diseases take over 🔗

Regional variations: why geography decides survival 🔗

The concentration of deaths in sub-Saharan Africa and South Asia 🔗

A different pattern in high-income countries 🔗

The decline of infectious-disease deaths in Asia and Latin America 🔗

India’s progress and its remaining challenges 🔗

Why progress is slowing and what it means 🔗